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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS a <br /> n <br /> OWNERS/ ,,e t' Qi TELEPHONE r <br /> }� 1 <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS 27377 eAp- t/--'/CCP-4A4 <br /> LC-T z v aim /'/N NE SE i� J <br /> LEGAL DESCRIPTION <br /> 1 0 / W 5 <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STA FRS 0 0 <br /> TYPE OF PERMIT(S): ,o <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 <br /> STRUCTURE/ADDITION USE: lee x1/Y /1•Aee-v/ Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 0 <br /> BUILDING CONTRACTOR: O r n , <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT rLANS .q vni <br /> WILL BE RETURNED. 0 <br /> o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y R <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) BUILD NG(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAR c <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 DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t? c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC. THE a 1 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN �) <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. ' <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. N <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (1I <br /> SETBACK AREA. W <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE DNLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. 'J <br /> O'k. per 1 'C , 7d �nmgat7 � <br /> 7. n <br /> °= wa' <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge z y y <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information I y b <br /> am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all N N$ <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree mt. <br /> permit county officials charged with administrating aunty ordinances or other authorized person to have access to the above- <br /> described <br /> bo -described premises at any reasonable a for the purpose of Inspection. <br /> OWNER'S SIGNATURE ! ! E)7 °e n ' Z <br /> [1 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY REQL �ED� a ZO�7 y H <br /> THIS PERMIT SHALL EXPIRE ONE YEA OM DA N o N <br /> BURN ,N� <br />