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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator v Q Z <br /> APPLICATION FOR LAND USE PERMITS �,l <br /> r <br /> OWNER //��/^ t)�4 �r�/////�, TELEPHONE <br /> •�lICCCCUU O <br /> MAILING ADDRESS <br /> 7 <br /> PROPERTYADDRESS <br /> LEGAL DE CRI TI N(see tax receipt) GDf✓ � � /f1, 15*'17 C <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ M-� O <br /> TYPE OFPERMIT(S): ❑ SUBDIVISION ❑ kN P/4-ro m n 7 <br /> FILLING/GRADING ❑ CAMPING UNIT " )'C <br /> STRUCTURE/ADDITION USE: �T SM13� lllC N <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> �'/i� m2. <br /> BUILDING CONTRACTOR: .YLG ir <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 ' <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <br /> ±� v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m , r�� <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V . <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Io <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 <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. 5D 0 <br /> ' o <br /> 3E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATKi , <br /> a NEEDED. 61D ��l <br /> � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. , <br /> CONDITIONS OF PERMIT: AUG 1 l ?0p� �1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT43UR/VF 1 <br /> ISSUANCE. rr C U C>2. REMOVAL OR CUTT3. NO GRADING OR SHIOREOLAND ALTERATIONS ARETREES ANDI ON ALLOWED UNLESS S EC F CALLIS RESTRICTED ALONG YLINE. zO/V //VG T <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SET <br /> 5.&V, 1ddCn/BACK AREA. ' t � <br /> l L W WIN 08aFr�i <br /> 6. m am X <br /> v m C y y o <br /> 7. o w m <br /> _T m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP (� 9 Y ) Y Y E <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m i m N <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> �i <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 /> ; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m IE <br /> authorized person to have access to the above described premim : rn e at an reasons f r the purpose of inspection. c: <br /> SIGN HERE ? vi <br /> gnat a of owner or n con rector) (date) ( ` a i <br /> ZONINGMINIST /T�O``R <br /> \\� U`A v ' <br /> <�'`\THIIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE u ooh SLS <br />