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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( n c <br /> APPLICATI N FOR LAND USE PERMITS Et <br /> n � <br /> OWNER //V- TELEPHONE (-(76 -225- <br /> MAILING <br /> (7 —22 MAILING ADDRESS �-, G I ' 'I/ 41 <br /> „a <br /> PROPERTY ADDRESS O Pa <br /> r J <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING❑ CAMPING UNIT ❑ BUNKHP�USE0 59.692(1V)GAZEBO ❑ DECK ❑ I^ o <br /> STRUCTURE/ADDITION USE: 5G�"ee� V_G z <br /> Home/Cabin; Commerciijl iness; edroom; Deck; e ) S ? p <br /> 1�✓'L569 t'j 6005TVN . (Q fUI G <br /> BUILDING CONTRACTOR: ,b I 01 <br /> F <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �0 I 3 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. N o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES ti o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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 v. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. .^. p <br /> -I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. I O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C' C1 <br /> r z J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 3^c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION(S RESTRICTED ALONG SHORELINE. n J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. B I d <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, EYC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> aoro <br /> 7. AR F$ M <br /> 9 o=.0g <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 Information e <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this Informatlon.I ^ <br /> am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 further accept all <br /> liability that may be a result of the County of Burned:relying on this Infbrnation I am providing In this application. I agree to n <br /> permit county oRiclels charged adminlstrating county ordi ncas oY other authorized person to have access to the above- S n <br /> described premises at any re bla Bm r the pu ose of ecbon. ^ y <br /> OWNER'S SIGNATU <br /> (date) <br /> n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED d» M y H N <br /> �T�HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N 8 o <br /> G�Q�SOh ('CrSfi'uCho� `f o7 <br />