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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator e b c <br /> APPLICATION FOR LAND USE PERMITS <br /> w m <br /> OWNER /`Y'^ <br /> Jr w'-1G�/r'�75t/lA cit A �V f-1liVk PHONE (01 ,7I_4 iO, a <br /> L./ 1(015,7 <br /> WJ` J <br /> MAILING ADDRESS ,�- <br /> c�� CM�f�NNtZ j% tdc.-ejjVw� <br /> PROPERTY ADDRESS <br /> Cili2G �'I,OWe�3�'blt I VE �' o � <br /> W <br /> LEGAL DESCRIPTION <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMITS : <br /> ( ) n\ 5 <br /> N v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(SV)GAZEBO ❑ DECK ❑ n C <br /> ,�.� II TO v, <br /> STRUCTURE/ADDITION USE: JMrA o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 2, <br /> _��.. <br /> BUILDING CONTRACTOR: pp <br /> � w c <br /> A PLOT PLAN MUST BE ED O I PRO .� <br /> VDN AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +a <br /> WILL BE RETURNED. ,0 W <br /> 0 <br /> 4 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) rC <br /> 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO 8E SHOWN OR DRAWN TO SCALE. a' <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3. U1 <br /> AND INDICATE NORTH (N). "iGBUILDING <br /> (S) <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINS) �[ n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> z <br /> (OHWM) OF LAKE, STREAMOR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> a <br /> SHOW THE LOCATION OF THE WELL W SEPTIC TANK ST AND DRAINFIELD DF AND ALL DISTANCES <br /> oz <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. U <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. f1 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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 0 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,tl A LA yy <br /> VI) <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. j <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 <br /> SETBACK AREA. O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. y C7 <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge x�,C <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information p 2.: <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I H <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all 9 N`='•w y^' iy <br /> liabilitythat may be a result of the County of Burnett relying on this Information I am providing a <br /> Y ty p gin this application. I agree to .. <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o n <br /> described premises at any reasonable time for the purpose of inspection. t A GI�o E > <br /> SIGN HERE G R g"z �a •21 <br /> (signature of owner of building contractor) (date) <br /> ZONING ADM NISiRAT dim F lan(gar-) <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Q 8 <br /> b y Oargj Chemo-�-bavid7ai�-er 3-aV-06 <br />