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L <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54672 Office of coning Administrator _ y <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER �POr, C L\1SJ CfM?n TELEPHONE iia-- 3a1 - o ,13 <br /> MAILING ADDRESS <br /> 3'19 <br /> O 5110 <br /> c (� <br /> PROPERTY ADDRESS % <br /> i1.41 EvCr ,rccr, P03b,. ognc w S4101 <br /> 7 <br /> LEGAL DESCRIPnoNO f 7 n� I9 - - .-/7 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION❑ DEC GARAGE/ACCESSORY STRUCTURE Nf r- <br /> BUNKHOUSE O 59.692(IV)WEBO O STAIRS O FILLING/GRADING O CAMPING UNIT13 r - <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE O <br /> STRUCTURE AOOTfION USE: 1 OrQ <br /> C-7)DJ�N `o <br /> ora n; mmero ugness; <br /> BUILDING CONTRACTOR: <br /> C) <br /> z <br /> AP LOT PIAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS r <br /> in <br /> WILL BE RETURNED. r S <br /> r <br /> DIRECTIONS FORREQUIRED <br /> RED DIMENSIONS <br /> DRAIONS OR DI (AREAL O TOP VIEW) _ - <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES -H BE SHOWN DRAWN S(EB) <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURESPORCHS RUC AND ALL NEW R <br /> BUILDINGSATE NORTH(S(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v= ; U <br /> AND INDIGENE NORTH(N). '� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)THE TO ALL LOT LINES,(B)BMARK G(S) - t <br /> TO CENTERLINE , ROAD,(C)BUILDING MEASUREMENT AREAS, <br /> THE ORDINARY HIGH WATER MARK - C <br /> (OHWM)OF TAKE,STREAM OR RIVER AND WETLAND AREAS,AMD(0)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK PST)AND AND DRAINF[ELD(OF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT ISBANARPLANNED AND SHOW AREAS TO LD GRADEDRA FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN OWNERR,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE <br /> PIANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> U <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE BEAKED 50 AN ONSITE VERIFICATION MY BE GONE WHETI ' I(, p O <br /> NEEDED. IiF�V,') 7V gJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: - C <br /> - � C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 15 RESTRICTED ALONG SHORELINE. _ t <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 <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 /> 7 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of in, = _ <br /> knowledge and belief it Is true,correct and complete. I acknowledge that 1 am responsible for the dmn am accuracy of au - <br /> Information contained in this application(including any accompanying schedule)and l further declare that l recognize that this <br /> information l am Providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability that may be a result ofthe County of Burnett relying an this information l am providing inthis <br /> application. I agree to Want county officials changed with administrating county ordirances or other strummed person to have _ <br /> access to the aboye-deacriti,4premises at any reasonable time for the purpose of inspection. y ,T OWNER'S SIGNATURE <br /> (date) _ = 3 p,S <br /> ZONING ADMINISTRATOR <br /> v o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL E PIRE ONE YEAR FROM DATE OF ISSUANCE <br /> iT< �N <br />