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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 3. U� <br /> OWNER ^ n - � �ITELEPHONE <br /> MAILING ADDRESS IF'J 1 ( 2-q <br /> ( 2-C��4�C7� `( � �� � ��q O <br /> ajk <br /> PROPERTY ADDRESS <br /> `J Peri v �,af <br /> LEGAL DESCRIPTION o UQ <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION STAIRS ❑ <br /> ,P o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 (�( <br /> STRUCTURE/ADDITION USE: �y�Ipllti. z ^ <br /> T(-Home)Cabin; Commercial/Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: ` C•C e— US{rUC-t-(la� J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS GJ <br /> WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) Oki O <br /> 0 <br /> � n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW r^-n <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, th 'ro <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Ti^ Uj 3 <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. <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 <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. - z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. e v <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. IIYlUSI 6e > 75 � �c,m GHWm S .Shcw�� D Flo+ plz t{r� „i <br /> - -,� sry� antooaoro <br /> n 3 c c a 61 <br /> 7. 3L�w °c Now <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 detall and accuracy of all Information <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 Countyof Burnett Wisconsin In determiningwhether to Issue a permit. I further accept all " 4 n—W <br /> liablty that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to �n o ^U o t" <br /> permit county officials charged with administrating county g[dinances or other authorized person to have access to the above- <br /> described premises at any reaso le time for the urpojC of bspectlon. 3 :`° w o <br /> q° <br /> ._. .a.) <br /> / om � <br /> OWNER'S SIGNATURE � �L�-� <br /> A . <br /> (� ' (date) y'� s9 i <br /> ZONING ADMINISTRATOR _ 1 /7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE l S <br /> Cj— „N .4- to l-k ✓ vnat �ee) <br /> 8 <br />