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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n Z <br /> APPLICATION FOR LAND USE PERMITS a c!J <br /> OWNER /� y, /S O �hl S TELEPHONE 4— <br /> ^ <br /> MAILING ADDRESS S Z1/ <br /> (f�76 �l ✓ri ^` �t _ it <br /> PROPERTY ADDRESS <br /> 2,P/7Z <br /> CDS Cl1sO� <br /> LEGAL DESCRIPTION OJ •-/ / .S�' ) rzlD,)1 'yG�� c y <br /> < 6 � <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ S AIRS ❑ o <br /> TYPE OF PERMIT(S): ^ <br /> FILLING/GRADINq❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 69.692(1V)GAZEBO ❑ DECK ❑ <br /> Zj <br /> A�C-o e 3" es <br /> STRUCTURE/ADDITION USE: z <br /> (Home/ in; C/o �ercialI,Buussiiness; Bedroom; Deck; etc.) e P <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLCT PLANS y <br /> WILL BE RETURNED. O 3 <br /> z -c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I o <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, a <br /> AND INDICATE NORTH (N). r0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) I '� <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MA K <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND(D)LOT DIMENSIONS. n ,a <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DIS rANCES ? C <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES, r; J <br /> S. 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. - <br /> - I <br /> NOTE: NEEDEDQ/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ~ <br /> J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. F I� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAG ONLY. I E <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> ^ F >ue X> O 'O. <br /> 7. '= n <br /> F n, <br /> US <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge Z 2 R �� <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application(including any accom vying schedule)and I further declare that I recognize that this informs ion I i > <br /> am providing will be relied upon by the County urnett Wisconsin in determining whether to issue a permit I further accept all <br /> liability that may be a result of the County of nett relying on this on I am providing In this application. I agree to n OOn <br /> permit county officials charged aedmin r ng county ord" as o er authorized person to have access to the abo e- o ` f1 <br /> described premises at any ble[i r the purpo sp n. <br /> OWNER'S SIGNATU E O '�� o <br /> (date) $ �> g +P. <br /> �a <br /> ZONING ADMINISTRATOR <br /> E i <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> � m ! (e-r P✓ (,a G U 46C4�rL��opnx a� s 7-/3-6 <br />