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kyrnett County 7410 Co.Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° �o <br /> APPLICATION FOR LAND USE PERMITS . <br /> 0 <br /> N <br /> C S <br /> m <br /> OWNER TELEPHONE o O Q w <br /> q L/ m O <br /> MAILING ADDRESS / 0C2 L�� <br /> o s <br /> PROPERTY ADDRESS,?( J � f o <br /> y�.moi,✓ <br /> 5 Sul <br /> LEGAL DESCRIPTION(see tax receipt) j C )CZ;;'L. /\3(y —(—q N /(o W �(I <br /> L[S; m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 20 ADDITION ❑ U j n <br /> TYPE OF PERMIT(S): �7 a (� <br /> FILLING/GRADING ElCAMPING UNIT El SUBDIVISION ❑ 1�/�u L <br /> STRUCTURE/ADDITION USE: �Q�pi CJla_ 21C!EI�J�i t ( 7cG✓z>L.fs <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: `,j <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N 7� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T a ` <br /> ?f o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. P <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 W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0j <br /> MUST BE SIGNED AND DATED BY THE OWNER. \ E <br /> / 4 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATLQ � HEN y <br /> n' \I1/ <br /> NEEDED. (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. l ✓j,� \�r^� S�,a <br /> CONDITIONS OF PERMIT: 3� V ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT�A�. ��� ' <br /> ISSUANCE. <br /> 3. NO GRADING OR H2. REMOVAL OR ING REOF TREES AND LAND ALTERATIONS AREOAILLOWEDIS TRICTED ALONG UNLESS SPECIFICALLY LINE.�O/��Ac(Qwv <br /> PERMITTED. ''VV N <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER U <br /> SETBACK AREA. i, � )) <br /> 5. &" -7-b� (.,Sed �Y �( 119a S�/ �C vN <br /> v/ m WMC)imafm <br /> 6. m 3amxaD � <br /> v C <br /> 7. Z y � o <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y t7 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m o.^n to E <br /> : : 70 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E m $ : u,o me <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C�Q: <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am �C E <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to hav ss to the above described premises at any reasonable time for the purpose of inspection. m CD o <br /> m <br /> SIGN HERE d' <br /> e of ow building contractor) (date) °' <br /> ZONING ADMINISTRATOR ;f — n : `• : <br /> 69 69 <br /> t�UUU . 'fit TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />