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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator - a <br /> APPLICATION FOR LAND USE PERMITS i <br /> N „ W <br /> OWNER T <br /> C) O h tv am % /A0 /L) TELEPHONE � �Q <br /> v <br /> n <br /> MAILING ADDRESS /_ .� �2P,Q Cl �ilP S, rdy NA- <br /> PROPERTY ADDRESS <br /> 1�✓ �z / i I '�`'�1 <br /> LEGAL DESCRIPTION ' eC�i'o 'V �' +� ,ni rl,� Y0 -RhNpe lb Wosj a <br /> rJg <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE O ADDITION ❑ STAIRS ❑ 'o <br /> TYPE OF PERMIT(S): ,p <br /> FILLING/GRADING❑ CAMPING UNIT ❑ BUNKHOUSE O 59.692(1V)GAZEBO ❑ DECKl15"� ^ <br /> STRUCTURE/ADDITION USE: �� �t�✓ �C X� (%1� <br /> z <br /> (Home/Cabin; Commercial Business; <br /> Beedroom; Deck; etc.) o_ P _ <br /> BUILDING CONTRACTOR: P/q- C/a /� it I, �^ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> WILL BE RETURNED. x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ^-r <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, w —a <br /> AND INDICATE NORTH (N). j <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 IQ-,l l <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 c <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. — Cy <br /> � y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. �I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G O <br /> r <br /> Y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 GAYS OF PERMIT. IL <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. tI O <br /> 3. NO GRADING OR SMORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,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. F <br /> 6. <br /> x >rn+ c X. > ' S <br /> 7. F <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge p Z <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information 7r c _ <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 EL <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 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- e n <br /> described premises at any reasonable time for the purpose of Inspection. m ,n, n u <br /> OWNER'S SIGNATURE r "c M / dK —�07 + 8 - 2 <br /> /� (date) a y "o_> <br /> ZONING ADMINISTRATOR J/� I[�(/Lt.���c.r <br /> E <br /> TOWNSHIP PERMITS MAY BE REQUIRED - »_ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N 8 <br /> { ✓✓n�� le-� der �ic-kPC/ L�'jo /oil Cele taysoh X1/9 a7 <br />