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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 <br /> OWNERTELEPHONE <br /> L�u�t as �loosl�t� (ps1 .43q• a as <br /> MAILING ADDRESS <br /> 10311 I O'1 Sy": N . o <br /> Q� T � <br /> PROPERTY ADDRESS 30a.8'S F,1 11 OT Z*N'5bn Rd <br /> fiRCei 1111`4U• Ta W176F n <br /> LEGAL DESCRIPTION a& T' 141 <br /> N I SW g <br /> SINGLE FAMILY DWELLINGJKGARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> S AIRS 0 <br /> TYPE OF PERMIT(S): II ^ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ D CK ❑ Z <br /> STRUCTURE/ADDITION USE: Ir�IJ <br /> (Home/Ca in; Comm, tial Business; Bedroom; Deck; etc.) ° t t <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET qF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLO r PLANS <br /> WILL BE RETURNED. O K <br /> F C _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) - <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TOE SHOWN OR DRAWN TO SCALE. .+r1 O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTIN�i BUILDINGS/STRUCTURES (EB)AND ALL NEW ,^rRt <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ,q <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWIN (A) BUILDING(S)TO ALL LOT LINES, (B) BUIL ING(S) I n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASU EMENT(S)TO THE ORDINARY HIGH WATER MARK N 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WET ND AREAS, AND (D)LOT DIMENSIONS. H Y <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTICITANK (ST)AND DRAINFIELD (DF), AND ALL DIS ANCES c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. d <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNEDAND SHOW AREAS TO BE GRADED OR FILLED. '' (1�,,1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARC��IIITER, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE _ 1 <br /> PLANS MUST BE SIGNED AND DATED BY THE OW(JER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ~ �� <br /> NEEDED. II. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIEMENTS WITHIN 60 DAYS OF PERMIT. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATIJN IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE,ALLOWED UNLESS SPECIFICALLY PERMITTED. ( t;, <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS] ETC.,ALLOWED WITHIN THE REQUIRED WATE <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> - z >`9 > - � <br /> 7. <br /> •e <br /> � .w. Bmc: <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my kno ledge Z r <br /> and belief It is true,correct and complete. I acknowledge that I art(responsible for the detail and accuracy of all informationp = <br /> contained in this application(including any accompanying scheduled)and I further declare that I recognize that this informs ion I <br /> am providing will be relied upon by the County of Burnett Wisconsl In determining whether to issue a permit. I further acc ept all <br /> liability that may be a result of the County of Burnett relying on thio 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 <br /> bo e-described premises at any reasonable time for the purpose of InspeLtion. m n :T T> <br /> e a -j <br /> 3 a <br /> B a <br /> OWNER'S SIGNATURE o n g a c-�' 2 <br /> (date) N : o o .in <br /> 3 <br /> ZONING ADMINISTRATOR o' M <br /> < : P <br /> TOWNSHIP PERMITS { AY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE • N <br />