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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 a . <br /> OWNER J DU G 10V'CzriY� i 1 ' 'aS �C�, TELEPHONE 95a <br /> / Q I , <br /> MAILING ADDRESS a(� g 7.3 �pry�r� )�P�+Gr Koh. 1 nbk ��I $�g3(� .Z J <br /> PROPERTY ADDRESS a aPPe,"''�l 553717 <br /> LEGAL DESCRIPTION /VF �lq Itl� '1 Cs- :S Lo <br /> SINGLE FAMILY DWELLINGX GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ yj <br /> STRUCTURE/ADDITION USE: m (1-- Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o G <br /> BUILDING CONTRACTOR: 5 fl Cf i"' �] 5-aao-a&aV I- Q-j <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> I� ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d <br /> tit' SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, b: J <br /> AND INDICATE NORTH (N). <br /> 6_ . SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK l' e <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. <br /> yt� <br /> SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> JTO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O S <br /> V6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE a. <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 WHEN <br /> NEEDED, Y <br /> THIS PERMIT 1S SUBJECT TO ALL CONDITIONS LISTED BELOW: RR^ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. rc Z J C> <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n d <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 ILvI <br /> SETBACK AREA. N <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 1 <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> >yaaoro <br /> 7. R g <br /> L=� xwo ` gwS <br /> I tletlare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge Y ,q„ m y <br /> and belief R Is true,Correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information c :; <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 Wisconsln In determining whether to Issue a permit. I further accept all o. <br /> liability that may be a result of the County of Burnett relying on this Information I am pmvkling In this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- R n <br /> desribed premises at any reasonable time for the purpose of Inspection. <br /> OWNER'S SIGNATU /// �/r/Gr <br /> �r C f-4 —,9 / c n S c 2 <br /> �J 1lv1V a 1 i�� (date) ,rs a 8 <br /> ZONING ADMINISTRATOR <br /> V <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATEOF ISSUANCE <br /> -jtet-Eei picLed up ey sw eon ► <br />