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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS a <br /> a <br /> oME � <br /> OWNER Maity <br /> TELEPHONE -6 <br /> MAILING ADDRESS <br /> UP <br /> PROPERTY ADDRESS 3 Q 3(;t p /,1 - Rd L I <br /> 66 � l�l.L <br /> LEGAL DESCRIPTIONn <br /> &MUla `] 5 <br /> DWELLING/BUILDING❑ GARAGE/ACE STRUCTURE ❑ ADDITION ❑ STAIRS 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK ❑ <br /> STRUCTURE/ADDITION USE:SJI Inv PCJOM ils*: <br /> (Home/Cabin; Commeltial Business; Bedroom; Deck; etc.) <br /> C— — <br /> BUILDING CONTRACTOR: c.�&—1 ? <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 2 <br /> WILL BE RETURNED. O 0 <br /> C oMd <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. a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW w <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, bt <br /> AND INDICATE NORTH (N). n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 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. o w z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 2. ° <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. C o <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. �} <br /> r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I C1 <br /> NEEDED. <br /> THIS PERMIT 1S SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' x p <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. 8 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (1'� <br /> SETBACK AREA. V✓ <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. T0g91IV <br /> 7. � , 9.1 R uwislZeff 7d <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,co.. 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 1 recognize that this Information I 'Dtl <br /> am providing will be railed upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all Ppc�-N g N$ <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to171 <br /> Permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o^ ry <br /> described premises at any me ble a for pu se of Inspection. t `e1 n / <br /> SIGN HERE ^ /® c3/ S 2 <br /> (signature of owner or uiiding contractor) (date) y : a_$S .� <br /> '�j� /1H ^pT w tel <br /> ZONING ADMINISTRATOR \/11 / 1y-� FI�to 2a <br /> TOWNSHIP PERMITS MAY BE REQUIRED O »_ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N 8 N U o <br /> Pel m�f I� �i maL �ed fv C'rl �d rv)aif-) <br />