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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o° o <br /> APPLICATION FOR LAND USE PERMITS - <br /> o <br /> ° <br /> OWNER (i1/'1/E / t/YVX/ / YV t7�L1/� 1 TELEPHONE Fav Y7)J m <br /> � �,� O <br /> MAILING ADDRESS <br /> 0 <br /> PROPERTYADDRESS �/ <br /> / -4 S <br /> LEGAL DESCRIPTION(see tax receipt)5�c_3Cj P40 ' 65/V1 1 PICS <br /> l O o <br /> DWELLINGIBUILDING . GARAGDACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): ❑ SUBDIVISION ❑ /, n <br /> FILLING/GRADING ❑ CAMPING UNIT T 1I'lls /✓ 0 <br /> STRUCTURFJADDITIONUSE: "i i��.S(� C�ULu-.SJ G1LX�`Se r�f� <br /> (Ho/meellCabin; Commercial Business, Bedroom, Deck, etc.) <br /> BUILDING CONTRACTOR: -/A�lDMME (OM45 <br /> m � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ;ac O <br /> O n <br /> DIRECTIONS FOR Pl OT PLAN DRAWING: (AERIAL OR TOP VIEW) r Z <br /> m j� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Am m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C .. O <br /> NORTH(N). m �D <br /> M <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 0 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE,LOT LINES. O� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS o ,� <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> REMOVAL2. <br /> 3. NO GRADING OR SHORELAND A TERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. p� / dr�uelz yo 6e remM'�. <br /> 5. ¢oC R1r�rdw aF f'"`'kl"5 Gi✓�-, W�INt CweYs I�1'`�' 16 / m iD m d n n fPhwm <br /> 6. Per b0o(er. T o m c N o <br /> per Q Z ° y ° <br /> o m T" [ m <br /> 7. i f9 0 <br /> y C9 2 i -tC <br /> I declare that this application (including any accompanying schedule) has been examined b me and it the best ac of <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of I ! m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 <br /> w <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determiningnformation I am <br /> sue a permit. I further accept all liability which may be a result of the Countyof, r -Ip�����!!!QQQQQ 444444������7 <br /> providing in this application. I agree to permit county officials charged'with-adgt�STing cyy id Bad nsoectionr <br /> authorized parson to ha=cc951Ot,/4Pove described premises at r1y saseh Rims fM t . p,�tpb P �+ <br /> m ni <br /> SIGN HERE - i. (d e) <br /> (signature of owner or building contractor) r�Ny <br /> ZONING ADMINISTRATOR <br /> ZONING go �o � � No <br /> TOWNSHIP PERMITS MAY BE REQUIRED �J <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />