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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITSCL <br /> y <br /> CD <br /> OWNER DD n t^ a{- SLt I r lc-- )4 Flag <br /> TELEPHONE 715 (�(� 3 Z80 0 0 <br /> C � 35 del b�►'y w� 5830 <br /> MAILING ADDRESS 31 737 J_`j_,6�� y �» (D <br /> '1 <br /> PROPERTY ADDRESS S a kA e- Q Z 52-0 0 2- <br /> i0 X69 S6s Sns 7"sF/ fZ�Su> i8 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION LJ54) 4'tELJ c <br /> TYPE OF PERMIT(S): O �u S. (n <br /> FILLING/GRADING 11 CAMPING UNITE] SUBDIVISION ❑ y: <br /> STRUCTURE/ADDITION USE: vi <br /> (HomelCabin;Commercial Business,Bedroom, Deck,etc.) � <br /> lir <br /> BUILDING CONTRACTOR: Ow z <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR m0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T ° Z <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> M <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ( c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO G <br /> BUILDINGS,ROADS, LAKE,LOT LINES. N <br /> D AND SHOW AREAS TO GRADED OR FILLED. ' <br /> CHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS � <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNE . <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN AR <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> 0 <br /> SU <br /> CONDITIONS OF PERMIT: 'Ia Vj <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2.3. NO REMOVAL OR <br /> OR SHIORENG LF TREES RESTRICTEDAND VEGETATION IS <br /> AND A TERATIONS ARE ALLOWEDUNLESS S EC F CALLY LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 'A m m 0 2 a f m <br /> 3 am x% SW <br /> O ; <br /> rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 17'c C <br /> a^ : i <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �_, m S : o : m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �.: m ; :1 o <br /> Is- <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 /> E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> m : ro: <br /> m E <br /> authorized person to have access to the above described premises at any reasonable time for the pur ose of inspection. m '• ; = , <br /> 1 Vy r_ 4 m : m <br /> ( <br /> SIGN HERE ? : a ate) i .�. <br /> (signature Or owner or building contractor) i ` K <br /> ZONING ADMINISTRATOR n:c <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY G <br /> THIS PERMIT SHAL4 EXP RE ONE YEAR FROM DATE OF JVJ"G <br /> �f <br /> Ile � 4onn r7lm //-/ py <br />