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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administratorit <br /> APPLICATION FOR LAND USE PERMITS Z W <br /> 0 y C 1 <br /> O' <br /> OWNER � 1]� yl�.� //A ' TELEPHONE <br /> MAILING ADDRESS <br /> VLBr0 <br /> flvA / mA) sn I <br /> PROPERTY ADDRESS ' O69 / — T-octo ko I a <br /> RWUTs 441e6 <br /> LEGAL DESCRIPTION o <br /> TYPE OF PERMIT(S): <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ I �. <br /> w <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ DECK f'p <br /> D�cy <br /> STRUCTURE/As <br /> DDITION USE; K <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) z ,� <br /> BUILDING CONTRACTOR: L ` <br /> y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. o <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) g <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 n <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). \ v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) ` y <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK c Y-)J: o <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. o' i <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 i <br /> PLANS MUST BE SIGNEC AND DATED BY THE OWNER. c <br /> s <br /> NOTE: BUILDING{STRVCiUP.E LOCATIONS MUST 8E STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN lJl <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> LAJ <br /> Vfl <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Iz04 <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. R <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN <br /> SETBACK AREA. THE REQUIRED WATER p <br /> z <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I� <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. j 1: <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge �^z a n m o a 0 Ra <br /> and belief it Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all Information R n P.a ls7 <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information 1 <br /> issue a permit. I further accept all <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 /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to <br /> described premises at any <br /> permit county officials charged IN admini <br /> rea a me r Strati county ordinances or other authorized person m have access to the above- <br /> e purpos of in eotlon. c E <br /> OWNER'S SIGNATURE <br /> n <br /> (date) <br /> ZONING ADMINISTRATOR �lI m Fell�oj�h <br /> V § � aaadz <br /> moo; -a <br /> TOWNSHIP PERMITS MAY BE REQUIRED y 5 o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE p <br /> {��✓mi-{ � �2�'-lir/ /Yl�i:c leG� � LCiGJlr�7C2 kY1G�bC/ /D'�0') N g�U o <br />