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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator M 0 Z <br /> APPLICATION FOR LAND USE PERMITS <br /> F O <br /> D <br /> OWNER s��`j�n �rY/ TELEPHONE G 3.5� <br /> MAILING ADDRESS <br /> /2,7,77 G /Cor 151, <br /> T� B Gn c m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) -Z-40-141 S ep f l Cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ c 6 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o; <br /> STRUCTUREJADDITIONUSE: T`�GOr,I'Lf �r/�C/SdYtGL/ m ' <br /> (Hom� Commercial Business; Bedroom eck; etc.) rn <br /> BUILDING CONTRACTOR: �'JD IZ LR W.5aY-' w <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C <br /> � (ND <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> M O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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 /> S. 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 pQ <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> o ) 9J <br /> CONDITIONS OF PERMIT: C � I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i 4UG t i <br /> ISSUANCE. �0 �� k <br /> 3. NO GRADING OR2. REMOVAL OR SHIORENG OLAND ALTERATIONS AREF TREES AND I AILLOWEDIS TUNLESS S EC FICALLY RICTED ALONG LINE. 3URN�� I P <br /> PERMITTED. Z COON4 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER ���NG <br /> SETBACK AREA. <br /> 5. <br /> n Wm> > <br /> 6. (D 3 CL(D a M <br /> m C y y 0 <br /> 7. Z pm0i <br /> O T G M <br /> m <br /> declare that this application (including any accompanying schedule)has been examined by me and to the best of my L7 c ID <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 an accompanyingschedule and I further declare that I recognize E 'D m M <br /> PP ( 9 Y ) 9 <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 m E ' <br /> providing in this application. I agree to per it county officials charged with administering county ordinances or otherm <br /> m <br /> authorized person t have ac s the o described premises at any reasonable time for the purpose of inspection. ' c <br /> SIGN HERE O a <br /> (a re of caner Ing contractor) (da ) `'` ` �' i <br /> ZONING ADMINISTRATOR i <br /> All <br /> TOWNSHIP PERMITS MAY BE REQUIRED dN o o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE V)I/j <br />