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C � O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y <br /> a RT1 <br /> OWNER r>nL( 'Do lade—. TELEPHONE �(2, '� ZL(^60`73 O ^ten <br /> MAILING ADDRESS 6419 3 X12 A,/e JC7 ' /d ' S 1 M � �St l ' <br /> PROPERTY ADDRESS J v 1_ 1 f� o G -� <br /> Z3G/a Saf�rU Gane. 5,41al�, ►V/z srl8 s <br /> LEGAL DESCRIPTION ,L `L'nd I- (p <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ v) �- <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING((�❑ ,C/A�MPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ .� <br /> STRUCTURE/ADDITION USE: CMIP, r 1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) iz <br /> BUILDING CONTRACTOR: Se �` ' 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. p o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW n <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, [n w <br /> AND INDICATE NORTH (N). .e <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) N z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK P <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. w \ <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. C>Q <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. o O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (yI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t/g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. p <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my knowledge d to c 4 <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 information I 9 c w' <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all Cin <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 E. <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> e O`2 Y <br /> described premises at any reasonable ti a for the purpose of inspection. E in:'a in o `ro0 <br /> OWNER'S SIGNATURE l/ I/ u< ( ` -`� to�w°i N G) :n =? j <br /> /V� n (date) 3 <br /> ZONING ADMINISTRATOR '/ I rJ(Gt1"1.� o �' e _ a d 2 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^ a� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />