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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c ro Z <br /> APPLICATION FOR LAND USE PERMITS a . <br /> /�, // h <br /> OWNER I MPHA �f�7'IP <br /> / TELEPHONE <br /> MAILING ADDRESS 2541 �fVD60oweloe <br /> j L' 1D o <br /> V "Jb <br /> PROPERTY ADDRESSRM <br /> � /' <br /> LEGAL DESCRIPTION rINQE � � <br /> f'srZ ECTIOu / �[1111GSN1� �OJL/o�°7M <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S); <br /> FILLING/GRAJD{;�1J�hG ❑ C/AMPING UNIT CI NKHOUSE ❑ 59.692(1V)GAZEBO DECK ❑ Q� 0 <br /> STRUCTURE/ADDITION USE: ///(/�/�MC� / //y A11Cx <br /> (Home/Cabin; Commercial Business; Bed om; Deck; etc.) o <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n O <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) OL( O o <br /> c <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 g <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, tM v �" <br /> AND INDICATE NORTH (N). J <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) (tj n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK C>Q — 3 <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 q o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. g <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p —1 O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE /1, E SJ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 5. W ' C 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN l <br /> NEEDED. i r <br /> _ d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 'Z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n a t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER I'-rh <br /> SETBACK AREA. O <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> 7. syy >nm p> <br /> rtF <br /> u � fy v x a m rtyy�yl <br /> HE ° New ri <br /> I dedare that this application(indudIng any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Inforation I g <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further acceptall in:« «�N <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 n n u g `�^ � o tom' <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- a <br /> described premises at any reason le time r the purpose of Inspection. td = <br /> OWNER'S SIGNATURE <br /> f i- /} (date) <br /> J l(`) F Vs a g <br /> ZONING ADMINISTRATOR � 10.61 Gjar y 0° <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRREE ONE <br /> E YEAR FROM DATE OF ISSUANCE <br /> • WW �wr lI/LC/��� C,C.J �' V / o u u o <br />