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A-p ��IS cxACy VeSS ON COMPUTER/SCANNED <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator C z <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER �\ TELE HONE Is <br /> c7 Y'6���1 a pb-ev\ zcTk�QY �yJC� _� <br /> MAILING ADDRESS 1 1 C' <br /> vv.a sy' IMT ��'or1 ;n� L �,(lr C' <br /> PROPERTY ADDRESS J , PC.2S <br /> CT <br /> LEGAL DESCRIPTIO 0 w <br /> SINGLE FAMILY DWELLING S3 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ ,R <br /> , <br /> TYPE OF PERMIT(S): <br /> FILLING/GRA4,'DING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ 9 r <br /> STRUCTURE/ADDITION USE: . cQ s4AXA&<- 2}-rt N ACC o� o m <br /> (Hom Cabin; Commercial Business; Bedroom-.;; Deck; etc.) <br /> BUILDING CONTRACTOR: �710 P1 ^PV C.2. C1jN :1--'VYC' i^ <br /> W + <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> WILL BE RETURNED. �O < 1V <br /> o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t <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) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK B <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 0. <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 0 .� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. CIO <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ti O <br /> NEEDED. r© <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G <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. B <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER r <br /> SETBACK AREA. _ O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATIO\/N.�„ <br /> 6. { l/ <br /> 7. ffmA � 92k ' <br /> Gw19 �' � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge El �, y <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o g? <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all �,o N`�g 7 <br /> liability that may be a result of Me County of Burnett relying on this Information I am providing In this application. I agree to m—"?:�^ r' <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o ' n <br /> described premises at any reasonable time for Me purpose of Inspection. I P n c = y <br /> OWNER'S SIGNATURE <br /> —J-4) <br /> �' �} (d <br /> VIm ) Ni : m n as l�1 <br /> ZONING ADMINISTRATOR F100(40n <br /> < : o <br /> TOWNSHIP PERMITS MAY BE REQUIRED H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C� S <br /> pe�iri( � -4- Ie.+P-r ma( led -fo Se-4 rierce-, 6-1q-m <br />