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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITSCD 0 <br /> r <br /> OWNER ✓ �Cift/ �12 �y yr TELEPHONE 7iS" 4f 77 Oil v CD <br /> cJLJO w �a <br /> uC-le, m Q <br /> MAILING ADDRESS 3 F <br /> r m <br /> PROPERTY ADDRESS /l g 7 :? 7"3j��Pd qW FgC- t ln/� y g 3 7 <br /> F- 2 G 2 01JS Or S. i3 XoDs, (SL a7 ,2J-37-18 t <br /> LEGAL DESCRIPTION(see tax receipt) Flfoec,,LV-O 3 JS 2/ 0 r 00 m <br /> 0 <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE 1:1ADDITION y p <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ^ty <br /> STRUCTURE/ADDITIONQSE: _&/ofe.r 8 X <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn ' <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 9 <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) O a X <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). m O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. o <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. Q� <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 MJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. -I <br /> q <br /> NOTE: NG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA7 WHEN <br /> NEEDED. o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ��jj c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER0t/A� <br /> ISSUANCE.2. REMOVAL OR NCUTT 'V <br /> OF TREES AND VEGETATION IS RESTRICTED ALONG <br /> NG <br /> 3. NO GRADING OR SHIORELAND ALTERATIONS ARE ALLOWED UNLESS SPEC FICAORY LINE. 20�CQUA T �/ <br /> PERMITTED. N� ' Y W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 00 m <br /> CD S a m a >7 <br /> 7. v a N y <br /> O m (OD G <br /> T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G W : A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 ' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem o ; m <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 furthe accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this app <br /> ation. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to ve access o the bove described premises at any reasonable time for the purpose of inspection. D E <br /> m <br /> m o <br /> SIGN HERE - % z 107 0 j <br /> " (sign tur f wrier or b ng contractor) (date) ` n <br /> ZONING ADMINISTRATOR J <br /> ie i» <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0�U <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Y/ILQ 1P <br />