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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> N y <br /> OWNER TELEPHYY1 c� J�n�c�l'_7 enc �c� �7 �•�G� SCC ONE r7IS -(- F34 - a3q{ <br /> MAILING ADDRESS 9 9 y <br /> —I ocJ / cY <br /> PROPERTY ADDRESS <br /> 3<74 q ...( 1l QQ � d <br /> Q.$ / PQe� �—G,f! P 1lGt'� Pan bG0� �'✓ I � d <br /> LEGAL DESCRIPTION Io <br /> See 52jj Qc6 menA <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ I J �'. <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT, BUNKHOUSE ❑ 59.692(1V)GAZEBO O DECK❑ ,e " <br /> r <br /> STRUCTURE/ADDITION USE: dam '( L) mon-�hS 10_31 <br /> (Home/Cabin; Comniercial Business; Bedroom; Deck; etc.) I^ z <br /> BUILDING CONTRACTOR: ° r'- <br /> y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. <br /> C ° + <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). g <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) N I c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK - 9 ` <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. 5 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES p - <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND 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 "I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> y G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: QJ <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 (n <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 'p <br /> =BACK AREA. IN <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. (� <br /> 6. <br /> 7. F <br /> I declare that this application(Induding any accompanying schedule)has been examined by me and to the best of my knowledge >n a a o 'V <br /> and belief It Is true,conect and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ^ °a s y=; <br /> contained In this application(Including any accompanying schedule)and I further dedare that I recognize that this Information I <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all El <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 /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- d a <br /> described premises at any reasonable time for the purpose of Inspection. S <br /> OWNER'S SIGNATURE . o' <br /> a <br /> ZONING ADMINISTRATOR \ <br /> TOWNSHIP PERMITS MAY BE REQUIRED y <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> 1'���m� �- � I�-�'-I-P T �'�G�r I�� 1-� ,J d h n YY� d✓-i-e � � c H �, <br /> W owti » <br />