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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Admiostrator z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER �� TELEPHONE <br /> MAILINGADDRESS ['ra�,b� •� <br /> C7 � <br /> PROPERTY ADDRESS <br /> J <br /> LEGAL DESCRIPTION c w <br /> B <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONFAIRS ❑ 'o 4 <br /> TYPE Of PERMIT(S): I c <br /> FILLING/GRADING ❑ CAMPING UNrr❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ CK ❑ ^ (� <br /> Cn Bch 3. <br /> STRUCTURE/ADDITION USE: H"Ux�SD r Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o P <br /> BUILDING CONTRACTOR: rG Cl3�✓I's v Ui <br /> ICY, <br /> C>7 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEEI OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLC T PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C - <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. trn O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ^-r - <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Mm' <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWIN : (A) BUILDING(S)TO ALL LOT LINES, (0) BUILDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEAS REMENT(S)TO THE ORDINARY HIGH WATER MAI tK a <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND(D)LOT DIMENSIONS. N y <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DIE TAINCES c <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 - `C <br /> PLANS MUST BE SIGNED AND DATED BY THE OVINER. - ry-- Q <br /> -1 0'1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (JJ - <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED B LOW: <br /> r � <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 �, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE.ALLOWED UNLESS SPECIFICALLY PERMITTED. R I_ �-- �P <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE k <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAG E ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. >; <br /> 6. <br /> s Ae>iv a X> C7S <br /> 7. F ,^a Cextr--E <br /> x� 3 <br /> I declare that this application(Including any accompanying ached k)has been examined by me and to the best of my knc ledge 3 r c ,j <br /> and belief It Is true,correct and complete. I acknowledge that I ai i responsible for the detail and accuracy of all informati in -'- <br /> contained in this application(including any accompanying schedul )and I further declare that I recognize that this informi tion I € n « 7 <br /> am providing will be relied upon by the County of Burnett Wiscons n In determining whether to Issue a permit I further ai cept all <br /> liability that may be a result of the County of Burnett relying on th s Information I am providing In this application. I agrei to <br /> permit county officials charged with administrating county ordinan es or other authorized person bD have access to the ab ve- <br /> Oesvibed premises at any reasonable time for the purpose of Insp ion. ¢ p u <br /> OWNER'S SIGNATURE e n i �,: 'b. 2 <br /> _ (date) H 'z 5 > .s1 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° C, <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> r�mt�- � I�tfe-� �rck-�a/ �� /��� ✓�and�j ~-Ed,=i�, a�t-��i� �-coo-off <br />