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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r Ql <br /> CD <br /> OWNER TELEPHONE �p / t,.D C�C� JIts-, <br /> MAILING ADDRESS 1-11 U 1ck,k% <br /> �/�� e1Z U) <br /> 1 'm <br /> PROPERTYADDRESS <br /> poG 190431 it. (sov'+ Lat3 <br /> LEGAL DESCRIPTION(see tax receipt)Le'f 4 CS m in 4 U a P e?O a b(e O7 m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE D ADDITION ❑ 1 y o <br /> TYPE OF PERMIT(S): Cj cP <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITIONOSE: To <br /> vac C4 x 3t-1 o <br /> (Home/Cabin; Commercial Busi ess;Bedroom, Deck;etc.) <br /> d ^ <br /> � 1 <br /> BUILDING CONTRACTOR: <br /> CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n = ,� <br /> M n O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> Tz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) 6 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF n , <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. X/ o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N i1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> CiJ O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI E WHEN o <br /> NEEDED. <br /> ti <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �/ Z <br /> CONDITIONS OF PERMIT: �� P i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE <br /> ISSUANCE. F>? <br /> CUTTING2. REMOVAL OR IS <br /> 3. NO GRADI G OR SHO ELAND ALTERATIONS ARE ALRESTRICTED <br /> LOWED UNLESS SPEC SPECIFICALLY <br /> LINI�� 'Y�A2V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATEE R v 1 V <br /> SETBACK AREA. <br /> 3 <br /> 5. „ C � � (��� <br /> A 0r DODO V <br /> 6. 3 'acOamA <br /> 7. Z CD <br /> m o " ' 3 <br /> a -n� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G _ p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize Wa m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- cD t7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am d <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T (D <br /> CD 07 <br /> CD <br /> SIGN HERE <br /> a <br /> (signal ner or buildingco ra�ctor)p-� (date) <br /> ZONING ADMINISTRATOR <br /> EA Eli <br /> U�fA N o N <br /> N N N O O <br /> O UO <br /> TOWNSHIP PERMITS MAY BE REQUIRED SGu? thuy (� <br /> nice Led l 8 6 ll), Id- :;13 -0,3 ;SSS_ <br />