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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator — Z <br /> APPLICATION FOR LAND USE PERMITS <br /> Cc <br /> OW NE ' ^/ TELEPHONE� !b.-s d j <br /> /1J CJ C/ r m <br /> o <br /> MAILING ADDRESS Q_ LN <br /> PROPERTY ADDRESS �� <br /> Z�3c10 9 /l/int( .PTJL�//9a; jwjay ISL/7 <br /> LEGAL DESCRIPTION C <br /> o / L y 1 <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STIR CTURE ADDITION 0 STAIRS 0r— <br /> TYPE OF PERMIT(S): �� <br /> FILLING/GRADING 0 CAMPING UNIT 0 BU HOUSE 0 59.692(1V)GAZEBO 0 DECK 0 <br /> 3 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; o;mmerual Business; Bedroom; Deck; etc1D A- <br /> .) <br /> BUILDING CONTRACTOR: , <br /> S01i yflLdis ) w/ i✓U. �,�Grat,►as /1ilA/ (�!r/ <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8 Va X11 SHEET 0 PAPER. AN INCOMPLETE OR ILLEGI LE PLOT PLANS <br /> WILL BE RETURNED. F <br /> < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O = Q <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I^ j <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, t p1 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) I 9J r1 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES w o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. m \ <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 , O ` 1n <br /> NEEDED. <br /> 00 <br /> THIS PERMIT IS SUBJECT TO ALL CONDCTIONS LISTED BELOW: <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. n z J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER d <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. <br /> sx �nc?' ' q <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge d r c <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 '- `^ M <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 <br /> result of the County of Burnett relying on this Information I am providing In this application. I agree to C~5 ~ � <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- e n <br /> described premises at any reasonable time for tZf Inspection. n `e <br /> OWNER'S SIGNATURE <br /> q (date) <br /> ZONING ADMINISTRATOR n VLA <br /> TOWNSHIP PERMITS MAY BE REQUIRED 2 M w' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> N <br /> P&ml-+-4- lehel, Ma iced -/D 7&/-V (�al lei ca � <br />