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Burnett County 7410 County Road K, No. 102, Siren, WI 54672 Office of Zoning Administrator R z <br /> APPLICATION FOR LAND USE PERMITS o <br /> R <br /> OWNERf k r' TELEPHONE7577 <br /> MAILING ADDRESS '7 ? 19 CLt✓LO{-� Y•�Iz fn/'�0 J. Ll't25 �Y!N� S��C✓ \ ' f <br /> R <br /> PROPERTYADDRESSn ti°r 16 <br /> a a�b() c c c �fX {�cG✓L 13 U/Z r,0 1,�7 t s y�_ � <br /> LEGAL DESCRIPTION , ? y <br /> doumnov S RcSorcT l,o?' 1A <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION K STAIRS 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING CUNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ <br /> STRUCTURE/ADDITION USE: — �� �Jf IA Jon pUrc- h Z <br /> (Home/Cabin; CommercialBusiness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 0 f< r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLO PLANS e w <br /> WILL BE RETURNED. x ; <br /> < M <br /> c_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> � 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. to O <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, I <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUIL¢ING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MART( a3 <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 DISANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETCh,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> ��I��I""""""��� a <br /> NOTE: STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE PvHEN <br /> NEEDED <br /> Z' W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 11 i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. '' ;c S <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. j n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATE <br /> SETBACK AREA. `y <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAG ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. E O' <br /> 6. <br /> s n3 a X €0 -0 <br /> 43 <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,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informationp - <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information I w 7 <br /> am providing will be retied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all N❑ W N '9 <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 r' <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the abo e- <br /> described premises at any reasonable time for the purpose of Inspection. j w O L e c> <br /> n <br /> OWNER'S SIGNATURE ( �(IIA;Lri <br /> �J I I� � i�1 t (d � ir w �I <br /> ��++���;; H a a, <br /> ZONING ADMINISTRATOR �ill�l� n <br /> ^Ip <br /> TOWNSHIP PERMITS MAY BE REQUIRED ? G <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> �eim� � d- l�-�e✓ mai led � �e�-ze, md��e �tea- � <br />