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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS UJ <br /> OWNER �rU(lA y ,— TELEPHONE 3;z G „333. 7-5-5-1 J5-1 <br /> MAILING ADDRESS75- � / ,.L .J <br /> .SSI fl3� � Q-) O <br /> T <br /> PROPERTY ADDRESS <br /> 8145 P4 fk S i k.7ld <br /> LEGAL DESCRIPTION }7 S <br /> DWELLING/BUILDING D GARAGE/ACCESSORY STRUCTURE D ADDITION D STAIRS D <br /> TYPE OF PERMIT(S): S 'O <br /> FILLING/GRADING D CAMPING UNIT D BUNKHOUSE 59.692(1V)GAZEBO D DECK D p <br /> STRUCTURE/ADDITION USE: <br /> o ' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) t7 .. C' <br /> BUILDING CONTRACTOR: Sej� W <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +f -C y <br /> WILL BE RETURNED. c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o _ <br /> j 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. RK <br /> m O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NE),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, t+n R <br /> AND INDICATE NORTH (N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK v <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. O0 a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c RJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE C <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> Q � O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, 0113 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n J <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 (} <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 /> 7. a 10- u o'o'w o'g <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 I am responsible for the detail and accuracy of all informationa <br /> v o c <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I ,� w w .d <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 ^ .J <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- A <br /> described premises at any reasonable tim . or the purpose of Inspection. m ^ `">M a <br /> �a - <br /> �14- <br /> OWNER'S SIGNAT -� (date) y��,� a g y E ,sf <br /> to l�!/ It/In <br /> S^ 'Sw t� <br /> 1 <br /> ZONING ADMINISTRATOR - <br /> TOWNSHIP PERMITS MAY BE REQUIRED p^' <br /> CWA <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Rlwf) e+4e/ ll d� 4! (Ylar� a- 14-0`7 <br />