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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator i G" <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER (�( Iliam-� Lia_v ✓le TELEPHONE j <br /> / CA <br /> MAILING ADDRESS 5O'1 / (2 �j� Sara Vbb T 53913 <br /> F <br /> PROPERTY ADDRESS / �� 3 1 I�, O Ln <br /> LEGAL DESCRIPTION c �' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION O DECK O GARAGE/ACCESSORY STRUCTURE O N <br /> o <br /> BUNKHOUSE O 59.692(1V)GAZEBO O STAIRS ❑ FILLING/GRADING O CAMPING UNIT O a U, <br /> COMMERCIAL BUILDING O COMMECRCIAL ADDITION O COMMERCIAL ACCESSORY TRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: - Q��h OrC�1 SCreo, c Cp <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: n �� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) p <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 r•+ b <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3 <br /> Q 11' 5 <br /> AND INDICATE NORTH (N). �`lI a YJ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) CJ o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �i Q <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. ` p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES <br /> SU <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. --r—. rIn <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE W o C)l <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 70 d w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. t� lcCl1 00001 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ) r 1 <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS W[THIN 60 DAYS OF PERMIT. W n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. UJ <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 /> ^ � annn � aoro <br /> 7� 's0 <br /> H ,' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 ,2 <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m r r r <br /> Information contained In this application(Including any accompanying schedule)and 1 further declare that I recognize that this v `_- D 9 <br /> Information I am providing will be railed upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I $w' <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 1 am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. ' ,;,�+;7, <br /> m °° o. 00 '^ o o a <br /> OWNER'S SIGNATURE <br /> n � > <br /> (date) rya <br /> �', s F y o <br /> 41 <br /> ZONING ADMINISTRATOR C7O" _ d <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE J ti o 0 <br /> ,.. n00000 <br />