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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administr r o <br /> APPLICATION FOR LAND USE PERMITS �. y U� <br /> OWNER TELEPHONE 3"o7 ` TJ,/ – W, I <br /> MAILING ADDRESS p J ,l¢i f. '/�L 1'Fi�1 M l j 5-597o - /5-8 <br /> PROPERTY ADDRESS I a p 7 - U _ I� � �4 5',w YO' <br /> SeU <br /> R T�Fo, �s < <br /> o7 J <br /> LEGAL DESCRIPTION LO 'q CSM V3 P60 C n C oU lT Lot7 ' 2. <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAI S ❑ c ,E% <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT 11V BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DEC <br /> STRUCTURE/ADDITION USE: p <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Y� ,L <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT FLANS C ` <br /> WILL BE RETURNED. A c <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARU1L OR TOP VIEW) -Tj a <br /> n 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, m v VU <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDI G(S) i o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK(OHWM) LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) v <br /> 4. SHOW T EFLOCATION OF THE WELL(W)SEPTIC TANK(ST)AND DRAIN ELLD (DF), AND ALL DISTA NCES �. N <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. 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. y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE Y HEN <br /> NEEDED. ..� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 7O <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 " I <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE DNLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> Cr <br /> S q n <br /> 7. <br /> S* O�.C _ <br /> I dedare that this appllratlon(Indudinp any aocompanying schedule)has been womined by me and to the best of my knov edge <br /> and belief K is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Infornatl6 0 2� yy <br /> contained In this application(Including any accompanying schedule)and I further declare that I recogniu that this Inform on 1 n �,,, «> b <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further a 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 o <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to thea O N s M Y <br /> described premises at any reasonable time for the purpose of Inspection. TF] �.o y <br /> OWNER'S SIGNATUREZ1�21� <br /> (date) <br /> Y-� lani - ry'vI <br /> ZONING ADMINISTRATOR t I n N <br /> r <br /> �.�/rri,-f- d-f�-1�-f�✓ rnCc c -lv Naiiv,an fl'i a /a �C7 <br /> TOWNSHIP P ITS MAY BE REQUIRED BURNETT C UN S <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCtONINGI <br /> Di, vi (I )Sb >l,cert c- J cack5on Tdw sh,j� PI rr7i/1AAO <br /> ov1 Vit y Oic e 7/.5 - 3 13 ,E <br />