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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y y <br /> OWNERA <br /> hoY►ra� m(P ,KQ TELEPHONE e <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS,Jg6j rj yQ/ e�1, y�•J��' `(/ �d11117/.1� n <br /> LEGAL DESCRIPTION :�q I � AC' !1 QP- , S 1 o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY Dray LLING LJ1 ADDITION f,ipIDUECCK ❑ IGGARtAGE/ACCESSORY STRUCT RE ❑ v� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO CI STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r- <br /> A <br /> 0 <br /> STRUCTURE/ADDITION ILSE: 140 ta P-i c <br /> Home/Cabin; Commercial Business; Bedroom; Deck; etc.) �._. <br /> BUILDING CONTRACTOR: e9 �l <br /> f <br /> C 111--rr— <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � o <br /> WILL BE RETURNED. <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m `' <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 m '' 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, l <br /> AND INDICATE NORTH (N). I c Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK E _ <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES y <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.,THEi (� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 �i N <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. F <br /> 7. daor0 aa 't <br /> N p"z 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my B ? � �q 9 P � w' <br /> knowledge and belief R is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all g, mn� d y <br /> Information contained In this application(Including any accompanying schedule)and i further declare that I recognize that this a Y m `O <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I $w' b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this o u ;,,6, 62 ,n, .p <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-desvlbed premises a ny reasonable time for the purp <br /> os <br /> e off I specbon. y <br /> D <br /> OWNER'S SIGNATURE <br /> nd' a = ado sx <br /> (date) o a > > 3 A d <br /> B� <br /> ZONING ADMINISTRATOR F ;- °c ws H c n t�i7 <br /> R , 5 <br /> OWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />