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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator ro z <br /> APPLICATION FOR LAND USE PERMITS a <br /> h m <br /> 6. <br /> 1 / a <br /> ll <br /> OWNER //��JmQn �QrnQ JGh�IScn TELEPHONE 952 �� �i4 CCem)) s <br /> MAILING ADDRESS Joh �Qn D�7 <br /> 9 Over Si Vt.!�i ar /7)A/ 55--7;7f <br /> PROPERTY ADDRESS I <br /> of titier GUT 5y�y3 <br /> LEGAL DESCRIPTION <br /> LOT C's <br /> I Cs l� I� P aa� <br /> SINGLE FAMILY DWELLING ❑ <br /> TYPE OF PERMIT(5) GARAG ACCESSORY STRUCTURE El ADDITION IA' STAIRS ❑ o <br /> : <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ DEC <br /> PP / ro <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin, Commercial Busme55; Bedroom; Deck; etc.) a z <br /> BUILDING CONTRACTOR: <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O 4 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL DQSTING BUILDINGS/STRUCTURES(EB)AND ALL NEW M C <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, c <br /> AND INDICATE NORTH(N). B <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) y p <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o i o <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. y <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. <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. y <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN �' I <br /> NEEDED. <br /> THIS PERMIT IS SURIECT TO ALL CONDITIONS LISTED BELOW: y <br /> i <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. n <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER H z <br /> SETBACK AREA. A <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge o v 9 n W O D O b <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information M 3 S = !EM <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I v_ <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to y " _ <br /> issue a permit I further accept all 3 <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 permit c v,C P i y <br /> county officials charged with administrating county ordinances or other authorized person to have access to the above-described o <br /> premises at any reasonable time for the purpose of inspection. m Y <br /> �_ <br /> OWNER'S SIGNATURE 6 C <br /> 4) m <br /> Y <br /> JI Il� 5 H <br /> ZONING ADMINISTRATOR 9 R. <br /> m ,: $ �a <br /> CCT 12 2007 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUVMNETT COUNI Y9 P <br /> ZONING <br />