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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 ; P <br /> a 7— F <br /> OWNER � tti v f r� �e ✓ �� � S TELEPHONE 7/ S-. 2 2,_ �O(� V � 90 <br /> MAILING ADDRESS At <br /> 3 y - z - 'yv /� v e C�mb�la� 54&A <br /> PROPERTY ADDRESS Sop oa"v'- ~ <br /> 2 SO I/ � e�.de ✓ 17� m �� s vd-�/ cS � <br /> C1 J <br /> LEGAL DESCRIPTION <br /> 5 w Y'( ,U E Y Y 5 3 ! 7- 3 <br /> SINGLE FAMILY DWELLING,;9 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS 0 0 �. <br /> TYPE OF PERMIT(S): <br /> s <br /> FILLING/GRADIN/G�❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK❑ ^� <br /> STRUCTURE/ADDITION USE: C. e— c--j i'-✓ C- <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: D 0.✓ I Cf c ✓ "✓ S <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS ,n <br /> WILL BE RETURNED. 3 —C <br /> o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n <br /> n <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, tti w <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) n <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. o <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. w' <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. = <br /> i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r '1 C,() <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> z p <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 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (,() <br /> 4. NO STRUCTURES,INCLUDING RETAINING WADS, ETC.,ALLOWED WITHIN THE REQUIRED WATER. I <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 /> n � Dr]m 09 <br /> 7. i' I'• �''ec �a <br /> b Zwe o0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that 1 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 <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further accept all <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 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for the purpose of Inspection. <br /> OWNER'S SIGNATURE <br /> r(^ n (date) o y, i o 6 > <br /> ZONING ADMINISTRATOR, `I' Qn (VIG� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> w: M: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE W w N N <br />