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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator A o <br /> APPLICATION FOR LAND USE PERMITS <br /> N N <br /> OWNER �O TELEPHONE'-7� <br /> I�77517 C' (-IVY1 pev P'�- Wa�, aa. O SV`��4 <br /> MAILING ADDRESS � p <br /> v < SE <br /> PROPERTY ADDRESS 14-s- �0 <br /> LEGAL DESCRIPTION ' <br /> 1'2tl� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESS Y STRUCTUP. v— ADDITION ❑ STAIRS ❑ gg <br /> TYPE OF PERMIT(S): y <br /> FILLING/GRADIW❑ CAMPING UNIT ❑ BUyKHOUSE ❑ 59.692j1V)GAZEBO ❑ BECK ❑ n � <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Cm i I/Bu�si/�}ess; Bedroom/;,Deck; etc.) <br /> BUILDING CONTRACTOR: �� C ! t-f L�//�S, w� �' J <br /> 821 <br /> o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +t <br /> WILL BE RETURNED. a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) .'; R <br /> 'n w <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c O I� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW 4i <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) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) �I G 9 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK i ,z o <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. F c <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF), AND ALL DISTANCES r <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. O <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rl o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE y <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. T <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> q m <br /> X e <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d J <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. R <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Q <br /> SETBACK AREA. C) <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. C> <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> g <br /> . <br /> g- <br /> 79 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <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 E »w H N S <br /> am providing will be relied upon by the County of Bumett 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. I agree to — 8 "'`^8 <br /> permit county officials charged with administrating county ordinances or other authorized person to have amiss to the above- a r� <br /> described premises at any re n time r[M Durposa of Inspection. <br /> sr <br /> a <br /> SIGN HERE S I 42;2_ Or o n <br /> (slgnabum of owner or building contractor) (date) <br /> z $ $„ e1 <br /> ZONING ADMINISTRATOR C ,ice : in <br /> G < nF <br /> TOWNSHIP PERMITS AY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N 8 <br />