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N 9 z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS N <br /> X15-381-11q e <br /> OWNERJChTELEPHONE ala-Rql-�N <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS 31„p a �GC-fhre L—n ¢ <br /> v�C <br /> LEGAL DESCRIPTION I 81()„�( )n I <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS 0 ' , <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 r <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: (\ h3i <br /> PL <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT ANS < <br /> WILL BE RETURNED. ':Yjs + )6-93-67 - H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AR1AL OR TOP VIEW) `" d <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 d rI <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, b 3 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) c 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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES p Q <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rn C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. f H`OZ� <br /> CA <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN = OI <br /> NEEDED. -I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (J.) <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 00 Ud C>2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ,o <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. '-- <br /> nNO7T TO BE USED FOR HUMAN HABITATION. J <br /> 6. /vv �Xca✓o.{z° {�Ilowe� Close '15 TIS C)hFWe^ U L <br /> � <br /> �o�u�l�be Cor�$r.s-(�,.��� SU' -tau+(�.�.— f <br /> ye P R R <br /> I declare that this application(including any accompanying sch ule)has been examined by me and[o the best of my knowledge > rt R c � <br /> and belief It Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all Information F 0-2 T V^i c <br /> Po <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information 1 <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all v, y <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- R <br /> described premises at any reason le time for the purpose of Inspection. v 8 N o <br /> o r <br /> Q <br /> tC o. n 7 Y <br /> OWNER'S SIGNATURE (date) n ° 6 0 R y <br /> ZONING ADMINISTRATOR ° <br /> � $ °a� Ky <br /> •'2 � ^a°° B7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED s <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ° <br /> H_ y: <br /> p N <br /> N O N U O <br />