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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 (D. <br /> r Cly <br /> o XJ <br /> OWNER ! cS Ci TELEPHONE 11,514,66-7457 WS . <br /> m <br /> MAILING ADDRESS YJ55 TMAOC'9 7Rkg4 l rAoQ fox&gj I&W .57 603 f 7 v E <br /> ,,r <br /> PROPERTY ADDRESS J DaQ(q Q W_ ee"d <br /> LEGAL DESCRIPTION(see tax receipt) _� /� —�� / S v \ <br /> 1 m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION y o <br /> TYPE OF PERMIT(S): c <br /> FILLIN ADING El CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> /n1 �!n 7 r� },, m <br /> STRUCTURE/ADDITIONUSE: WNL Q(.(O,P/ I Vl�/U C�+C�,�C.�Iadck kx'0 <br /> f me/Ca in;Commjercciial usiness; Bedroom; ck;etc.) ^� rn <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 834 X 11 SHEET OF PAPER. ANY INCOMPLETE OR ) <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 61 -n <br /> M H O <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) p m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r o p Z. <br /> n w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn T <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO It'll o� <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <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. IEI : <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT'��I <br /> NEEDED. UU �• �,l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. A,I <br /> CONDITIONS OF PERMIT: AUC w Q <br /> 1 ISSUANCE.WAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITBURNE�C'FO <br /> 2. REMOVAL OR IS RESTRICTED ALONG UN <br /> 3. NO GRADING OR SHIOREOLAND ALTERATIONS ARE I AILLOWED UNLESS SPECIFICALLY LINE. ZOING <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> gyp.} \SEEETBACK AREA <br /> 5. t �— M 0or-D0 >C 1911 <br /> v m C y o <br /> 7. Z r"nCOD <br /> 0 : <br /> O n�'< M <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my Lj E D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w rc, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Rf ': m E E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E <br /> i <br /> rther ept all Iiability which may be a result of the County of Burnett relying on this information I am (r E E m <br /> sue a permit. 1 fu <br /> providing in this ap cati n. I agree to permit oun officials charged with administering county ordinances or other m <br /> authorized person t hav access It thea desc d premises at any reasonable time for the pur ose pf Inspection. a <br /> -n i o <br /> SIGN HERE ` m m <br /> (sig ure of owner or build ntrractor) (d e) <br /> ZONING ADMINISTRATO / <br /> 8 € <br /> �Ilr d t&-oz/ `"o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />