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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS a <br /> <6i <br /> a) 3�y- 579/S e w) 30, <br /> OWNER o✓✓rV! e �9�( S' 7� TELEPHONE( 95'L) L?IJI- J ,/?t. 0 <br /> MAILING ADDRESS (n <br /> 1TY37 <br /> PROPERTY ADDRESS 3 / -7 Z W. l.� 3.0 <br /> � : o <br /> C fs z9 a ! 3r� �� T�. Plan f F.rst 1t,h� M J pa <br /> LEGAL DESCRIPTION <br /> Se/.+n a A c <- <br /> 'Jfr� <br /> VC <br /> al r�� 73u�nt !u„r-� WrJ c.ai.iia + <br /> SINGL FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIR ❑ or, �,� <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK <br /> STRUCTURE/ADDITION USE: e K Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: - Vf tfe .J I L /- � G L o O 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT P NS .n n <br /> ti <br /> WILL BE RETURNED. <br /> o J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ren <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, en w <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDIN (S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK R <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C7 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE 4 y w <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r ' <br /> NEEDED. pv'U <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <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. F i <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE 0 JLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> z 'Jy ynm O > 7 <br /> ' R <br /> 7. m rRyy'' <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowlec ge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contalned In this application(including any accompanying schedule)and I further declare that I recognize that this Information 1 2 <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accepl all o .p <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 /> N o �^u o .r. <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- ��♦ <br /> described premises at any reasonable time for the purpose of inspection. m Va p m a = y <br /> _� c � <br /> OWNER'S SIGNATURE <br /> (date) 6z o 6 aw t�iJ <br /> ZONING ADMINISTRATOR _ E. M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w w <br /> R'rn(4 fv �OriV7'42 e- <br /> __ i I <br />