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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administ ator n Z <br /> APPLICATION FOR LAND USE PERMITS P <br /> a <br /> 4Aryr) S- comber <br /> OWNER o a v) ' 1,1.J /hdZrSO TELEPHONE ' <br /> U nn �� I 1 B <br /> MAILING ADDRESS 6 (41 De V;Is I-a kQ U� V"�,, 7 e bS� VJr T S 4 O /pq v - <br /> n <br /> PROPERTY ADDRESS <br /> LJ � <br /> O <br /> c <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION STARS-11 0 <br /> TYPE OF PERMIT(S): .o <br /> FILLING/GRADING <br /> 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 3 <br /> STRUCTURE/ADDITION USE: c o t <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) _ <br /> BUILDING CONTRACTOR: Lp <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 3 S <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tn•1 (✓') <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y I �' <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) BUILD] G(S) W c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK _ n <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. NW4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 0. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. V <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE g. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. O <br /> NOTE: BUILDING/STRUCIURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN <br /> NEEDED. � U� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C p U <br /> Z ) <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 <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 O <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. 0 <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. <br /> > n7' Rmot �$ cltro+'7 <br /> 7. �7 ,�w' Oe. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my know) dge ..y C <br /> and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Informatic n I <br /> am pviding will be relied upon by the Cunty of Sumett Wisconsin <br /> Indeterminingrwhether o Issudel�permit�Itfurthegrac t all <br /> liabilitythat may be a result of the Countyof Bumett rel providing <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- n <br /> described promises at affreatilonablir time for the purpose of Inspection. <br /> OWNER'S SIGNATURE <br /> (date) S >w <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' <br /> H: N: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 N <br /> prrn�j 4- l e-kk1' r 10eed (Ah &I N vld el�St a� �o� <br />