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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS a <br /> y y <br /> / n <br /> OWNER TCU c.T ^/G TELEPHONE <br /> MAILING ADDRESS Lam. ��ie��F� �� —fJpd V.UD �IN• S�6y "1' 0 <br /> E <br /> n <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> 5 <br /> TYPE OF PERMIT(S): <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STA51: o �� <br /> FILLING/GRADING ❑ CAMPING UNIT 0 BUNKHOUSE 0 59.6992(1V)GAZEBO 0 DECK 0 ^� n <br /> STRUCTURE/ADDITION USE: S lrS 7 r�LQ- la e,'-7 z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: SF G o <br /> 14 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS vni til <br /> WILL BE RETURNED. O� p <br /> o S <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 — R <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW ti R <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 93 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. IN <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. w' pp� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. R N o Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE q. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. O <br /> NOTE: NG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDS r � <br /> NEEDED. 'h <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rI h�Jl <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 7� <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. A,5 m4d,Fr ed <br /> R g 1 <br /> rFa W R W <br /> 7. Fao =.;; o <br /> I declare that this application(Inducing any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief R 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 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 L,u$r u o <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree to n .w <br /> permit county officials charged with administrating county ordinances or other zed person to access to the above- o^ r1 <br /> described premises at any reasonab time for the purpose of Insp mom, pp w.y+'_? y <br /> OWNER'S SIGNATURE <br /> // (dj a) H o e$ <br /> ZONING ADMINISTRATOR �` F(a h <br /> o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 U U o <br />