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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER <br /> (NO..(k-d- TELEPHONE gSZ ili.u14�--L1�/jF�°/l Li a V� <br /> MAILING ADDRESS V I-+L4L( <br /> ro <br /> PROPERTY ADDRESS Zl!_33�-3 � 1 ^pil]1 1 LOLL <br /> LEGAL DESCRIPTION <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): �- <br /> FILLING/GRADING ❑ CAMPING UNIT CI BUNKHOUSE ❑ 59.692 1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: 1V\ (, NnLtIV�lA9. � �� <br /> (Home/Cabin; 11Comm1ercrcial�Fussiness; Bedroom; Deck; etc.) (, <br /> BUILDING CONTRACTOR: I/1nLt j �,.1(Y L O_L_—ML.� Iny�l WJ <br /> Y_ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 3 <br /> WILL BE RETURNED. <br /> O � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m ;\ <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) W 3 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O .° <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. i; <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 _ IJ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. C3' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n VV <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. F <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. d <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. p <br /> � >r) >y £ l�7 <br /> 7. A N 4 <br /> EF <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge c <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information ,� o <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> aproviding will be relied upon b the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all <br /> liability that may be a result of the County of Burnett relying on this information I am providing In this application. 1 agree to <br /> m <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- 8 n <br /> described premise a[any reasonable time for the purpose of Insoecti <br /> SIGN HERE . <br /> (signature of owner or bulqjlr4 contractor) a z7 <br /> ZONING ADMINISTRATOR 7 <br /> Tub <br /> TOWNSHIP PERM <br /> THIS PERMIT SHALL EXPIRE O EF gANce0uNT' y w w <br /> o <br /> / n�� 1�t k✓ mailed fa kl�s � Nar�fs-6°f` `q-G-2 <br />