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I N <br /> 1 <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator R Z <br /> APPLICATION FOR LAND USE PERMITS d <br /> y'�l o a <br /> OWNER f /1 /J O F� TELEPHONE / _ _ <br /> 1 t0 a o <br /> if I <br /> MAILING ADDRESS VL1 <br /> J C P1 ) n <br /> rLJ I <br /> PROPERTY ADDRESS <br /> / ) I'1 % 'T"q C I w <br /> LEGAL DESCRIPTIO n J <br /> "S /a w of LJ is k)w <br /> SINGLE FAMILY DWELLING 0 GARA E/ACCESSORY STRUCTUREIK ADDITION 0 S AIRS 0 b <br /> TYLE OF PERMIT(S): n <br /> FILLING/GRADING 0 CAMPING UNIT; 0 BUNKHOUSE$, 59.692(1V)GAZEBO 0 D CK 0 I 3 <br /> STRUCTURE/ADDITION USE: Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: <br /> CT <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEETii PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOPLANS r H <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (AREAL OR TOP�(IEW) <br /> � n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO yrE SHOWN OR DRAWN TO SCALE. nni o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTIN BUILDINGS/STRUCTURES (EB)AND ALL NEW ^—r , <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DEC S, PORCHES AND OTHER STRUCTURES, ,� ^- <br /> lip— <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWINq: (A) BUILDINGS)TO ALL LOT LINES, (B) BUIL ING(S) O() c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAF K P 9 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WET ND AREAS,AND(D) LOT DIMENSIONS. car v <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DIS IANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m' Y O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNER AND SHOW AREAS TO BE GRADED OR FILLED. = LA <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ET .,THE - <br /> PLANS MUST BE SIGNED AND DATED BY THE OWJNER. - • <br /> —I 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STOKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. 7V' Uj <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BE.OW: <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. x <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t0 4J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS AREJ ALLOWED UNLESS SPECIFICALLY PERMITTED. & I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAG ONLY. G <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> sp �ns 'x>7. <br /> o 'a <br /> n g3 � rc, t� <br /> 9 <br /> I declare that this application(including any accompanying schedu )has been examined by me and to the best of my kna ledge z ^ 5 <br /> and belief It is true,correct and complete. I acknowledge that Ia responsible for Ne detall and accuracy of all informati n ` <br /> contained in this application(including any accompanying schedul and I further declare that I recognize that this inform ion I M.N;M",i <br /> am providing will be relied upon by the County of Burnett Wisconsl(h(11 In determining whether to Issue a permit. I further a ept all EL �— <br /> liability that may be a result of the County of Burnett relying on this Information I am proviQing In this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the ab s- c C n <br /> described premises at any reawnalb)ki for the purpo of Inspection. 6�w^ c1 _'D <br /> n k' �'a � �l <br /> OWNER'S SIGNATURE `�0 ;; .M . <br /> n . S: Z <br /> (dae) <br /> z enFE <br /> w En <br /> ZONING ADMINISTRATOR F10"I <br /> TOWNSHIP PERMITS MAY BE REQUIRED C » «y N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O N € Z» <br /> �z�m�� <br /> 4 J�e 4?r UJO by Oafy �wensd ly r,7 <br />