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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c <br /> APPLICATION FOR LAND USE PERMITS a <br /> an <br /> OWNER re0 l CiIflr INH til / TELEPHONE <br /> VV G e <br /> MAILING ADDRESS /1 �0 D�f AN S� Z7 <br /> O <br /> -t- <br /> PROPERTY ADDRESS 208z� ivc1- TSk4"J <br /> Ip <br /> LEGAL DESCRIPTION G1 <br /> o � <br /> DWELLING/BUILDING O GARAGE/ACCESSORY STRUCTURE O ADDITION'K STAI S O <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING O CAMPIING UNIT O (BUNKHOUSE O 59.692(1V)GAZ€B011 DE K O 4 <br /> STRUCTURE/ADDITION USE: Ca,b LN F\ 17ec)L S4 yl W 41, o <br /> (Home/Cabin; Commercial(Business; Bedroom; Deck; etc.) p <br /> BUILDING CONTRACTOR: &f e V, W UI z <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 i,X11 SHEET OF OAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. < .. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SjiOWN OR DRAWN TO SCALE. rM <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING B ILDINGS/STRUCTURES (EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, ORCHES AND OTHER STRUCTURES, m o0 <br /> AND INDICATE NORTH (N). g <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUIL NG(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREM NT(S) TO THE ORDINARY HIGH WATER MAR 1 � .n <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLANDIAREAS, AND (D) LOT DIMENSIONS. c m Z <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TA K (ST) AND DRAINFIELD (DF), AND ALL DIS NCES �. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED ANP SHOW AREAS TO BE GRADED OR FILLED. <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, :. C,w <br /> --i 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE I VHEN <br /> NEEDED. C' <br /> C, r N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r <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. r� 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLPWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER n , <br /> SETBACK AREA. /w C) <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> yy a6p � <br /> 7. r' ,�, F N L 7J <br /> I declare that this application (including any accompanying schedule)h s been examined by me and to the best of my kno edge m ` C <br /> and belief it is true,correct and complete. I acknowledge that I am res nsible for the detail and accuracy of all informatio <br /> contained in this application(including an accompanyingschedule an I further declare that I recognize that this informat n I 'w i <br /> PP ( 9 Y ) 9 <br /> am providing will be relied upon by the County of Burnett Wisconsin inetermining whether to issue a permit. I further acc pt all ..N c, <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree ,o o �^ o t. <br /> permit county officials charged with administrating county ordinances op other authorized person to have access to the abo <br /> described premises at any reasonable time for the purpose of inspection. y <br /> OWNER'S SIGNATURE h-x-(X �� 2 /i"(�( I 1 Zoe <br /> oqaQ (da e) $ S <br /> '�77 <br /> ZONING ADMINISTRATOR CV ^n o. ! H <br /> < : <br /> c <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 o <br />