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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator - <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER Ji I I �'� �VUS TELEPHONE <br /> MAILING ADDRESS <br /> 13�x 9 Pi v-,.e Zslanal M N <br /> PROPERTY ADDRESS19 •,- I 1 <br /> 5 f2�InboW IQ�f � � <br /> LEGAL DESCRIPTION t _ <br /> c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZESO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING'0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin; mmercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: n i6 <br /> J1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS C c <br /> 00) <br /> WILL BE RETURNED. — <br /> T, <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) �' o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. e I v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). SJ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) S—L) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND(D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DISTANCES c Q A) <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <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/Iv lvv <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I� <br /> NEEDED. UJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> � 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER N M1 ! O <br /> SETBACK AREA. po \\ <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. N <br /> NOT TO BE USED FOR HUMAN HABITATION. j <br /> 6. <br /> 7. b o o d 4 y <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m Z $ ° 3 ' . =' 7 <br /> PP ( 9 Y ) Y y 3. o ,T 7_E. a. V r r- . <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible/or the detail and accuracy of all Ii >_ <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this E. > ' _S <br /> Informatlon I am providing will be relied upon by the County of Bumett Wisconsin In determining whether to Issue a permit. IE- c R e : S <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this = "a <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have i g <br /> access to the above-desalbed remises at an reasonable time for the u <br /> Y purpose of Inspection. c w e = 6 Y <br /> y ' 8 �8y <br /> OWNER'S SIGNATURE R. <br /> (date) s-s9 c <br /> . 6nFla <br /> ZONING ADMINISTRATOR ��G <br /> 2 m <br /> TOWNSHIP PERMITS MAY BE REQUIRED a �' <br /> PERM- EEY FROM pAE�nn SS <br /> -eIYYId-tQ� / � <br /> T!W-TZl ,/ w r� 80008 <br /> 3+t9 2138 <br />