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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS <br /> �soL/ 7 R� <br /> OWNER ��/�fJry TELEPHONE �/ c,/7 q� c 1 <br /> MAILING ADDRESS ZZI-B C`_�'� , �, � / S °� p <br /> �� � rn <br /> PROPERTY ADDRESS A <br /> LEGAL DESCRIPTION ° J - <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE 11 ADDITION 0 STAIRS ❑ <br /> TYPE OF PERMIT(5): �, y <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK ❑ <br /> STRUCTURE/ADDITION USE: 6M60 (�'�] <br /> / N - o <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck; etc.) J I' <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/3 X11 SHEET OF P1kPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C ro <br /> WILL BE RETURNED. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � <br /> .if' ALL REQUIRED DIMENSIONS OR DISTANCES TO BES OWN OR DRAWN TO SCALE. O <br /> Y. SHOW THE LOCATION AND SIZE OF ALL EXISTING BIL OWN <br /> (EB) AND ALL NEW c <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, ORCHES AND OTHER STRUCTURES, <br /> / AND INDICATE NORTH (N). <br /> d SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREM NT(S) TO THE ORDINARY HIGH WATER MARK 5 <br /> "� (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND REAS,AND (D) LOT DIMENSIONS. o y z <br /> p. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES ?. 9 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w <br /> J57 INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O o 0 <br /> .ff IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITE , ENGINEER, BUILDER, CONTRACTOR, ETC.,THE g, y 93 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER <br /> y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKE SO AN ONSITE VERIFICATION MY BE DONE WHEN O <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. F OI <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. H '� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ET--., ALLOWED WITHIN THE REQUIRED WATER Ca <br /> SETBACK AREA. a <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FI R PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6 NOT TO BE USED FOR HUMAN HABITATION.Oh� 5� 15-Dq <br /> 11 ^ qy aaoro <br /> o R � 9 an 'aa <br /> 3b ow <br /> I declare that this application(Including any accompanying schedule)h s been examined by me and to the best of my knowledge F, w c y <br /> and belief It Is true,correct and complete. I acknowledge that I am res onslble for the detail and accuracy of all Information v o 2 ? Y <br /> contained In this application(Including any accompanying schedule)an I further declare that I recognize that this Information I 2; <br /> am providing will be relied upon by the County of Burnett Wisconsin In ete"Ining whether to Issue a permit. I further accept all Q Now o <br /> liability that may be a result of the County of Burnett relying on this Infi rmation I am providing In this application. I agree to <br /> permit county officials charged w th administrating county ordinances o other authorized person to have access to the above- o C1 1P <br /> described premises at any rea able 8fne r purp is of Idspem w0a° O N s -� > <br /> 2 0 d 7, <br /> OWNER'S SIGNATURE v z <br /> (date) <br /> ZONING ADMINIST TOR - <br /> lh 7Fla6 qaq �: <br /> TOWNSHIP PERMITS MAY BE REQUIRED O. <br /> THIS-PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> e�m�� lP,h-ler mci led t-o l0a.n�p-.14—il S153e-J 6-6711 <br />