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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Admi istrator — z <br /> APPLICATION FOR LAND USE PERMITS <br /> N (� <br /> n <br /> OWNERDd 14 5 e n ,k TELEPHONE (951- Y 3 6- 776 <br /> V <br /> it <br /> 9iS-� 6 -7x37 �1� 1869r s <br /> MAILING ADDRESS / ,t Tr / (� <br /> /OBD l✓prcl a ve N O <br /> 1 �1 <br /> PROPERTY ADDRESS g <br /> ,.L0A e o r <br /> LEGAL DESCRIPTION <br /> S 3 / `FD Z /7 C�AL/IOh J bc� , •✓,=� O� �in t g <br /> SINGLE FAMILY DWELLING 11 GARAGE/ACCESSORY STRUCTURE�( ADDITION ❑ STAIRS E! o <br /> TYPE OF PERMITS): ( <br /> FILLING/GRADING❑ CAMPING UNIT D BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ MECK D C.I 3 <br /> STRUCTURE/ADDITION USE: '-fb r4_ e <br /> z <br /> �n I� (Home/ abin; Commercial B loess; Bedroom; Deck; etc.) C� e P <br /> BUILDING 1C.ONrTRACTOR: 1'e7'P S r ,-4 .5Z(n S o p !,A„�..,L. c' <br /> +-a.nfl S 7J U�rII— <br /> A PLOT PLAN MUST B PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PL T PLANS 3 n <br /> WILL BE RETURNED. p <br /> x � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tni I O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW v <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUI DING(S) n <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER M RK I 3 <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 DI TANCES c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> w <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, El C.,THE W y <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> —1 ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DON 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. z 1 <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. E I� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE R <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORA E ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> s7t: > > <br /> m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my len wledge � Z =C n � <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informat on - <br /> Contained in this application(including any accompanying schedule)and I further declare that I recognize that this inform tion I v e A Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further a cept all <br /> liability that may be a result of the County of Burnett relying on thisapplication.I am providing In this I here [o <br /> permit county Officials charged with administrating county ordinances or other authorized person to have access to "- n.s S �•'Js =- <br /> r' <br /> the ab ve- a f1 <br /> described premises at any reasonable time for the purpose of Inspection. F O v w y <br /> e � <br /> OWNER'S SIGNATURLN-� ' �� ` �O O <br /> I Ron ' <br /> (date) h : a > E in <br /> ZONING ADMINISTRATOR 6( I ! �I ' m <br /> /�-� o / <br /> 'a : In <br /> TOWNSHIP PERMITS MAY BE REQUIRED «' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N € u <br /> D� �e,�k4R_r 6 L�u,�lc5 Ran L S-1 D`� <br />