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Idurnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> OWNER e a e TELEPHONE <br /> rn /� r� L m <br /> HOME ADDRESS � G lrusfl4tsil� kt`I� pe,r ,,� �Jr 73 uxbU✓M6 vn� r o <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> o <br /> Lr-F= <br /> LEGAL DESCRIPTION(see tax receipt) �O I`��g1I rYp/ (�/(Q(U /S'� S� �K PC� (� g z p �j,�y �u/(,�DWELLING/BUILDING 9 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ox ,p� Un <br /> TYPE OF PERMIT(S): k C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o it'd-9 441 O^ a <br /> / � C N_ <br /> STRUCTURE/ADDITION USE: Pow R 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc Q �e(� U) � r <br /> BUILDING CONTRACTOR: � � L �' CUSY FI u dor �rZ r- <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 (� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p " "� <br /> ;a N �. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y it <br /> J <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. I m <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 9j Q <br /> BUILDINGS, ROADS,LAKE, LOT LINES. -I ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. J N J� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CO T CTOR,ETC.,THE PLANS OI 0. o C> <br /> MUST BE SIGNED AND DATED BY THE OWNER. �� £ <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN NSITE VERT I AT E WHEN ^ O <br /> NEEDED. I w <br /> C� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. OCj -* o <br /> CONDITIONS OF PERMIT: ev / % S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER 7' <br /> ISSUANCE.2. REMOVAL OR CUTTCCA'/C1Q,/�/ <br /> 3. NO GRADING OR SHIO ELAND ALTERATIONS ARE ALLOWED UNLESS SPEC F CALLLY L OF TREES AND VEGETATIOIS RESTRICTED ALONG 'Yy v•Ty / <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED Vfl TER <br /> 5. SET` BACK AREA.'Vf �,�/L � /' JJ / <br /> 6. y m 3 n m m <br /> Z <br /> �t - <br /> 7. o m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my GC <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ID m0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access t the above described premises at any reasonable time for the purpose of inspection. T <br /> m <br /> /q m <br /> SIGN HERE � <br /> (sig ature of w r uildi tractor) (date) <br /> 16 <br /> ZONING ADMINISTRATOR _5-�� C ' <br /> TO NSHIP PERMITS MAY BE REQUIRED d <br /> V <br />