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Burnett County 7410 County Road k No. 102, Siren,WI 54872 Office of Zoning Administrator I o <br /> APPLICATION FOR LAND USE PERMITS <br /> N N <br /> H <br /> 7 . � <br /> 6 <br /> OWNERIng TELEPHONE a <br /> tJ e-tCrr�) <br /> MAILING ADDRESS 0 <br /> �7 1 v� VCV[ IV�dlllll r l_ < <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION CSL 0 S, <br /> DWELLING/BUILDING 11 GARAGE/ACCESSORY STRUCTURE❑ ADDITION ❑ STAIRS ElTYPE OF PERMIT(S). <br /> FILLING/GRADING❑ CAMPING <br /> 1UNIT <br /> -1❑ BUNKHOUSE 1159.692(1V)GAZEBO El DECK F5 ro � <br /> STRUCTURE/ADDITION USE: fC y._. <br /> A\ <br /> (Home/Cabin; Cogmmerdal Business'; Bedroom; Deck; etc.) c <br /> BUILDING CONTRACTOR: 1V�1"��I,ICAtitG... ��ICS�fS .1�LL - <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C '� <br /> WILL BE RETURNED. pp <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> C. 6 <br /> 5 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <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). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS) c <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 9 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN Ir�ll 1 <br /> NEEDED. <br /> 6 � <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: 'O 5 <br /> � a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <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 <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 /> n 7y D(�b7 � 9p b <br /> 7. � �• � 5o e <br /> 3�•2 ao � : ? as o-.i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge g, Z w f9 H <br /> and belief It Is true,correct and complete. I admowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application(including any accompanying schedule)and I fuller declare that I recognize that this information I ^ ry <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to!saw a permit I fuller accept all <br /> liability that may be a result of the County of Burnett relying on this Infomwtion I am providing in this application. I agree to permit <br /> county onldals charged with administr- fig county ordinances or other authorized person to have access to the above-described S A <br /> premises at any reasonable time for the purpose of Inspection. 'D 6 0 c: H <br /> SIGN HERE a J Oil a 2 <br /> (sig orb reof owner building contractor) (daft) Q iE $8 c41 <br /> ZONING ADMINISTRATOR < : p <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY _ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCQONING U 8 U <br />