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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator � o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. � � <br /> N � <br /> OWNER �A R B/`I rt K '�.`!�V t� TELEPHONE �,�'G�"` �,'��"32'U1r1--- �p <br /> .-.-. 7 � O <br /> MAILING ADDRESS 1�Iv1 �N� �' � P����� �/�� , �� ��� .� r <br /> (� o <br /> PROPERTY ADDRESS I <br /> •- t q3 3fo3 S2'1 Talo Rey h! - eR�� 1. 0 <br /> LEGAL DESCRIPTION(see tax receipt) 2���t��. il, � ��sJ�O ��'f' 4� C 15�Ih1 V i P1 �21'7�- <br /> DWELLING/BUILDING ❑ GARAGE_/ACCESSORY STRUCTURE ❑ ADDITION lAI �� 3 I ur o <br /> c � <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CA(M�PING UNIT ❑ SUBDIVISION ❑ a IQ ` <br /> STRUCTUREIADDITIONUSE: •�aNU>Ly Rnn�1 4- ©��� �.URtY�svl `� Eti) ���.� � 0.r"1 <br /> (Home/Cabi ;Commercial Business; Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: ��� '�� r f� �T��Cr=T��/�� m <br /> � � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN B'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: AERIAL OR TOP VIEW O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v �j p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). � <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <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 � <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS �_ � <br /> MUST BE SIGNED AND DATED BY THE OWNER. �'� F � <br /> uz <br /> 1 / � 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT f51'B��r(B,F EN � o <br /> NEEDED. "_���"�71��� � <br /> (TIONS LISTED BELOW. J �� o <br /> THIS PERMIT IS SUBJECT TO ALL COND O�,l' <br /> CONDITIONS OF PERMIT: e � B <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N�� <br /> ISSUANCE. <br /> 3. NO GRADING OR SHIORELAND ALTERAT ONS ARE(ANLOWEDTUNLESS SPEC F CAORY LINE��/`/�itCOEI/Vh_ <br /> PERMITTED. �Y�7 � l' <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m chi rn ODaO V <br /> w <br /> � 3o-mxa � � <br /> 6. -� � � N N O = 3 <br /> Z �, � O � � <br /> 7. � T� m <br /> I declare that this a licatlon mcludin an accom an in schedule has been examined b me and to the best of m — r^ ' � O <br /> PP (� 9 Y P Y 9 ) Y y O c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � d � .n <br /> a � cn � <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize � m � o : m0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Oc G� <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 OC m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other � <br /> authorized person to have access t above described premises at any reasonable time for the purpose of inspection. m `D o <br /> `D m <br /> m <br /> ��— IR-n� <br /> SIGN HERE' � E a [ <br /> (sign ur of ow r wilding contractor) (date) <br /> ZONING ADMINISTRATOR � � ` �� <br /> fA fA EA EA� N <br /> �G �a'b-S' � � o � �oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED �a 3c1�_ � <br /> Q U /X fl- <br />