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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> \ APPLICATION FOR LAND USE PERMITS <br /> OWNER II ' 1TELEPHONE o <br /> MAILING ADDRESS /L'l ``� '�JU / /� �l� T //�j /� (.f�L- "TI to <br /> Ca(lD AJC/ ri7 ^ l77C (� ) <br /> PROPERTY ADDRESS <br /> SAl f3�a9 Rk2w fUEA)LA-) _ 1 <br /> LEGAL DESCRIPTION - <br /> TYPE OF PERMITS): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK C GAUGEIACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial BUvness; Bedroom; Deck;etc.) <br /> CC ee z <br /> BUILDING CONTRACTOR: <br /> n r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vr X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS <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, <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)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK - ) <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. °' d <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS, LAKE, LOT LINES. b <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. L ` <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE - <br /> PIANS MUST BE SIGNED AND DATED BY THE OWNER. \ L <br /> r, <br /> NOTE: BUILDING/STRURURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBIECr TO ALL CONDITIONS LISTED BELOW: n 1 <br /> F <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION O RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR ESS INCLUDING <br /> ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �hJ <br /> 9. NO STRUCTURES,INCLUDING RETAINING WALLS, EIC.,ALLOWED WITHIN THE REQUIRED WATER } <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE EDFORHUMAN <br /> HA PERMITN ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> nF > r. r,nn > Va <br /> cc <br /> Tin c F m <br /> Ideclare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 e] a 9 ? m <br /> knowledge and belief it is true,correct and complete. I acknowledge Nat I am responsible for the detail and accuracy of all c d d y <br /> information contained in this application(including any accompanying schedule)and I further deWre that I recognixtWt this => > ec <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit 1 _ = S <br /> further accept all liability pat may be a result of the County of Burnett relying on this information lam providin 1 015 m5 , S <br /> application. Iagree to Permit county officials charged with administrating counts ominanararot I �2 - ndy4c - <br /> have access W the above-described premises at any reasonable time for the purpose of inspection. ILC P u:^ �n > <br /> 8 � y <br /> OWNER'S SIGNATURE � m .°� if• ��(date) MAY 12 2014 >'� c n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ���r�UNY (N F d T <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING o- <br /> A,CSe � oo <br />