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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office oog Administrator 1 <br /> snin <br /> APPLICATION FOR LAND USE PERM :2 y <br /> s 9J <br /> TELEP ONE �- <br /> OWNER LpLJ// t/NL <br /> MAILING ADDRESS G 54 U <br /> go 8 <br /> u <br /> 1 <br /> PROPERTY ADDRESS � 'd <br /> G1 <br /> LEGAL DESCRIPTIONSQy T- 7/✓ / tJ Y NE FzX V DDITION ❑? o J , <br /> SINGLE FAMILY DWELLING ❑ GARAGWACCESSORY STRUCTURE ASTA RS ❑ q <br /> TYPE OF PERMIT(S): FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECKO <br /> STRUCTURE/ADDITION USE: room; D ck; etc.) <br /> (Home/Cabin; Commercial Business; <br /> BUILDING CONTRACTOR: 10) <br /> _ y (7 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 T4 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 5. <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLAT PLAN DRAWING: (ARIAL OR TOP VIEW) "1 <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 ,e <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) BUI ING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAR c ti Z <br /> (OHW M)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DIS NCES <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. t7 c <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 _ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. -� I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN J <br /> NEEDED. <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 7� i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE Iy <br /> SETBACK AREA. <br /> 5, ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGEONL . 2 <br /> N:;:TO BE USED FOR HUMAN HABITATION. g <br /> 6. J-90 8: <br /> .s <br /> 7. � <br /> tlha best of my len -F x rn 8AS. 'p0 .' <br /> declare that tills application(including any accompanYin9 schedule)has bean won lned by me and to ledge � <br /> I . <br /> �I <br /> and belief It is true,correct and complete. I adonowledge that I am nnponslble for the detall and accuracy of all informs n v ? ^«u H N y <br /> contained In this application(including any accompanying schedule)and I furMer declare that I recognize that this Inform tion I m ; <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further a capt all c <br /> liability that y be officials resultKarg of the with a umin ofrBumaW�O dlMrKesnor other authorizzed person to have aaccess to thea va- <br /> on I am providing in this application. I agrS I to <br /> permit countyist any red <br /> desalbad promises at any reasoroble time for the purpose of Inspeclbn. <br /> -/ <br /> OWNER'S SIGNATURE <br /> ZONING ADMINISTRATOR p E i <br /> TOWNSHIP PERMITS MAY BE REQUIREDN 8 N o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> P.�-r►wti�k � l?�I��e✓ ma,il��l -E� �d��/, �mu�z l d-a�D� <br />