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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS a (� <br /> OWNER /I77C� �j/Cr STELEPHONCE�Ale, 920 -,$5 O0 P <br /> MAILING ADDRESS IWIV 63�2 <br /> (A <br /> PROPERTY ADDRESS ,Cl <br /> /J< Ross bol-, 4,3 L:)t.xsyx <br /> LEGAL DESCRIPTION, <br /> SINGLEMILY DWELLING,t GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S): .. 9 <br /> FILLING/GRADING ❑ CAMPINN UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ G <br /> STRUCTURE/ADDITION USE: "'mE/ lkloy z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 3 <br /> WILL BE RETURNED. O� < <br /> 4 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tn2f t7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW n <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, to 'n° , y <br /> AND INDICATE NORTH (N). 91 � <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) r) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK I a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N w O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w o <br /> VV H J <br /> 5. 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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN -I�' <br /> NEEDED. -p <br /> THIS PERMIT IS SURIECT TO ALL CONDITIONS LISTED BELOW: .� <br /> r z < <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. n o <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. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. V" <br /> NOT TO BE USED FOR HUMAN HABITATION. F o <br /> 6. mus+ aueF rejUdea,2nH from Class s lake. u(ak: eon'5hr.zk-oo, "11,6) <br /> .x+u2(iu area requ,rts zpirnit fv. 6azebaSy_L- aA � ? aoro <br /> 7. <br /> °w o w <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge E3 <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 <br /> am providingwill be relied upon b the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all n;w <br /> P Y ty 9 D c 2)- <br /> E; <br /> )- N g7 <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 — Ci`^S <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- d n <br /> described premises at any reaetimer the pu se of Inspection. (�OWNER'S SIGNATURE (dat y o nZONING ADMINISTRATOF 10 a <br /> < I � <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w S <br />