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Burnett County 7410 CountyRoad K No. 102 Siren,, WI 54872 Office of Zoning Administral or ti <br /> APPLICATION FOR LAND USE PERMITS a 9. <br /> y ^ <br /> OWNERv �in � 5401.1 TELEPHONE <br /> I <br /> MAILING ADDRESS! 1971rc&/ & �Rp ,Qr)nbrn,r SN830 W <br /> PROPERTY ADDRESS A' l <br /> LEGAL DESCRIPTION o P <br /> < v <br /> 0 <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIR ❑ <br /> TYPE OF PERMIT(S): •� 4, <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK <br /> STRUCTURE/ADDITION USE: �mX. C�PabU <br /> r (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) vI" <br /> r ° R <br /> BUILDING CONTRACTOR: G/t'` >< L�11'I7/� 5 Lt;STI< 10KA(k)li raidd1GSO1y U�} l <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/3 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PU NS C 00 S <br /> WILL BE RETURNED. < �, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> � 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d <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). h <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) .� o <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. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES '` '.� o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. C� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED$0 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. i� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 6 x � <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 <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. III r <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> ODO '7 <br /> 7. <br /> 9 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledg 3 w <br /> and belief It 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 Information I ' Y <br /> am providing will be relied upon by the County of Bumet[Wisconsin In determining whether to Issue a permit. I further accept II a N c U c 'rod <br /> liability that may be a resuk of the County of Burnett relying on this Information I am providing In this application. I agree to J p ^c h <br /> Permit county officials charged with administrating county ordinances or other authorized person to have access to the above- S n <br /> described premises at any reasonabo time fof ihq Purpose of Inspection. y <br /> OWNER'S SIGNATURE <br /> o <br /> ZONING ADMINISTRATOR �f`Yl Fl ll ( �`h^)� a cw ts7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED d <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U 8 U o <br /> Pews) 4- d- lei*,I p(C!«d up btj berry Shouse s-as-o <br />