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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n z <br /> APPLICATION FOR LAND USE PERMITS g X <br /> H <br /> n <br /> OWNER TELEPHONE a <br /> rl2gR y 8 �P��2ic11 �G�i)3 —o9i5 o <br /> MAILING ADDRESS d' 1�3 8��er✓ 5r. S'7•Py�•L, ,y_ 55ri9 - <br /> p J <br /> PROPERTY ADDRESS �/(�'// f /Dv& LW y-ew/L 1340 AttyW S �g Ox G <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE ADDITION STAIRS 0 <br /> TYPE OF PERMIT(S): I^ .o <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(IV)GAZEBO 0 DECK 0 <br /> STRUCTURE/ADDITION USE: _ GIQ�CLG}� I� Z <br /> (Homne/Cabin;IC1ommercial Business; Broom Deck; etc.) o <br /> BUILDING CONTRACTOR: /`//v D 2E�(/ JA- eKCDi(7 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 3 <br /> WILL BE RETURNED. 77 C <br /> � o H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VIEW) <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW rC <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, trn 'O <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. oN, n• <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL D.STANCES <br /> TO e !"NGS, ROADS, LAKE, LOT LINES.. wo <br /> 1Uj Q> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 4 1 F <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. -^• �n .g-1 <br /> — V1 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ('r) <br /> NEEDED. <br /> THIS PERMIT IS SUBIECi TO ALL CONDITIONS LISTED BELOW: <br /> rr� <br /> — W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z C> <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n -� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. B 1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. w d <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. £ <br /> 6. 40 dilaOftel d Ago <br /> � 'jJ nm egQa� 7 <br /> 7. RL ^= <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledgem C e <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information ^ e g <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all <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 ofacW6 ch rged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at a reasonable ti for the purpose of inspection. m o rn>= y <br /> OWNER'S SIGNATU r/ �- e e g". <br /> (anW(1 (date) <br /> ZONING ADMINISTRATOR GI r h <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O 8 ti o <br /> v- J�h� �Ol, / �U <br /> ✓m) 1�f r �ic��d u p y hl/ ?-m-co <br />