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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 N <br /> OWNER H (6 ni t f ii)e TELEPHONE a —739-9_U.SLc) �T <br /> MAILING ADDRESS 19 Sa ? I e-S SL AJC M I I S SS`7 1O <br /> u J 7-7 LC I ,v-c f � ! A-]�� I <br /> PROPERTY ADDRESS a r� '7 / SC.m obo <br /> qy- <br /> LEGAL DESCRIPTION �Je I /_;D V <br /> TYPE OF PERMIT(S): <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE [IADDITION ❑ STAIRS ❑ -i- <br /> -� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK <br /> STRUCTURE/ADDITION USE: R <br /> (Home/Ca n; Commercial Business; Bedroom; Deck; etc.) Y <br /> BUILDING CONTRACTOR: s <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS < �1 <br /> WILL BE RETURNED. W <br /> C o <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. a <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). 9 <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 0 Qj <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. E <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES ty I <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - CX3 <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. w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: QJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. K Y C <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p <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. Cn <br /> (n <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge a n m $ t <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information _ <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this In I y 2 0 o 'o S' <br /> B e ,2 aoy ' °° r <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <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- $ <br /> described premises at any reasonable tlin/Ie for the purpose of Inspectio E N y H w c <br /> OWNER'S SIGNATURE <br /> (date) n + G B H <br /> ZONING ADMINISTRATOR C „ c <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Fi <br /> Perf le {-ref �orCked 410 bI Nerb��ra �ne <br /> N OHNV� <br /> O N U O <br /> C6)/OV.? 9-19-a <br />