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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator Q <br /> APPLICATION FOR LAND USE PERMITS <br /> r� a <br /> C <br /> OWNER a c' TELEPHONE p <br /> a , <br /> MAILING ADDRESS 1pl 37 Che5nv6 �all e �r'voK�-Vr� � � SS'�43 d 0 <br /> Qn <br /> PROPERTY ADDRESS / / / _ I Q Y Ge SV b p{I VI S IDb1 /`d� <br /> LEGAL DESCRIPTION Y CO W !— <br /> iaT l VIOLA. {-K 5016diUtson Sec 5 T38N /1150 <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS 0 <br /> TYPE OF PERMIT(S): V <br /> FILLING/GRADDING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK❑ <br /> STRUCTURE/ADDITION USE: PAT-j0 c <br /> (`Home/Cabin; mmercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ` SOn j nna <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. Xf < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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, re b <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) e <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK v <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. c v, z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. °�O G <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. E <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> i <br /> NOTE: BUILDING/STRUCfURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. \ <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. �a'' 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 V 1 <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. q <br /> 7. �. v 05 <br /> 9 C e w r <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge u, y <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information o g=' ; Y <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I : ,,, ,d <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all pik„, v g b <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree Co 8 "'permit county officials charg with I a ng county ordinances or other authorized person to have access to the above- C1 <br /> described premises at any rea nab I r purpose of Inspection. e= H <br /> 1 d� 01 <br /> wz <br /> OWNER'S SIGNATURE 2 0 <br /> (dabs) Q cv e s$w5 t+f <br /> 610, M� - <br /> ZONING ADMINISTRATOR <br /> o • � v <br /> TOWNSHIP PERMITS 01AY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w w <br /> yO t n N O <br />