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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> �9sz/)�f3/-77P - <br /> MAILING ADDRESS 17�d0 /L,TbI/�t/dE `!►Y.&!/�GLE�/l(/V .�,SDI�I� <br /> m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION �D��//�/��C�i(� ?"!i '4g'' <br /> SINGLE FAMhLY DWELLING ❑ ARA CCESSORY SYKUCTURE)iE ADDITION❑ STAIRSO <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING <br /> ,r❑,,,,,CAMPING UUN�IT�El \BUNKHOUSE ❑ 59.692(1V)GAZEBO EI DECK 11 � <br /> STRUCTURE/ADDITION USE: (&Mgrm _ <br /> (Homee//CCabinn;,Commercial Suusinwessss;Bedroom; Deck; etc.) o P <br /> BUILDING CONTRACTOR: *A2F K/.LG1LfLLa f.iw& r `Ir <br /> A PLOT PLAN MUST BE PROVIDED ON AN B `/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS rnn <br /> WILL BE RETURNED. 00 < <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) o N <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ( A C <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, w <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 9R <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. Nti <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES 0 � c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O W o Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE n ON <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> H <br /> NOTE: NEEDEDG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (,U <br /> (� ul <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r Z O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. J <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (T <br /> SETBACK AREA. I <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> 7 � ,nroga <br /> nmvv � <br /> . <br /> -'RS � w �s <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge "m C? <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o y <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I e, <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all G N o w o -d <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 t. <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- e <br /> described premises at any reasonable time for the purpo a o91spection. to V�Ba m s Ln y <br /> 60rH <br /> R � <br /> OWNER'S SIGNATURE ZM I da ,' v' <br /> ZONING ADMINISTRATOR �f / l LQ�( n rr,,'' = �` t� <br /> W < °_ <br /> E (Tj v <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE S o <br /> ✓61 le+4c�- fn ikd � 6red6(� CllarL 9-6-61) <br />