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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 2 z <br /> APPLICATION FOR LAND USE PERMITS d . <br /> OWNER { 1 h <br /> TELEPHONE ° W <br /> Gsl- yy2— rJ3if2 o �) <br /> t� <br /> MAILING ADDRESS 3st 7 V Ah LANE 1040BukYl MN 55/25 <br /> T I <br /> PROPERTY ADDRESS 6 p 15 PEKE [,,4KE /('oAD, W68$TF�� W/ 5ySg3 1-- <br /> 1/ > A <br /> LEGAL DESCRIPTION P[L Goy 1„QT 1 �. <br /> SINGLE FAMILY DWELLING 13GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ S <br /> TYPE OF PERMMS): TAIRS ❑ o <br /> FILLING/GRADING ❑ CAMPING UNIT❑,, ,B,U>NKHO�USE ❑ 59.692(1V)GAZEBO 1 DECKA <br /> MA.[�C, <br /> STRUCTURE/ADDITION USE: DECK rPA <br /> (Home/Cabin; Comrrfercial Business; Bedroom; Deck; etc.) Io ° <br /> p <br /> BUILDING CONTRACTOR: Nomle O ojejk C" <br /> T-1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y¢X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT!PLANS <br /> WILL BE RETURNED. O 3 <br /> A < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0— <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. trns d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDQNG(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK E <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N �, <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <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. i <br /> -' GJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !y <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATERO, 0 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE,ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> a7. <br /> �Ob <br /> q9 <br /> 3 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my kn ledge c y <br /> and belief tt 5 true,torted:and Complete. I acknowledge that I am responsible for the detail end accuracy of all InformatIo N o <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Infoon I w - Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all `Now 0 7 <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 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the atimie- <br /> described premises at any reasonable time for the purpose of Inspection. 3 ^� Lj 4 T = y <br /> 0 <br /> OWNER'S SIGNATURE <br /> m F(a�1 ter, (date) <br /> ZONING ADMINISTRATOR <br /> < o <br /> TOWNSHIP PERMITS MAY BE REQUIRED " C <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w S w <br /> rm�+ a Int lei rna- ped -to Wc� <br />