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C R Z <br /> Burnett County7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrato a ° <br /> APPLICATION FOR LAND USE PERMITS N: <br /> 6 <br /> OWNER ! /I/ih TELEPHONE <br /> MAILING ADDRESS ) LhV�MY (.0 S.3 V 1 <br /> PROPERTY ADDRESS V(C�"_ n <br /> LEGAL DESCRIPTION <br /> J-t-IC (.C.A.-A 0.C61J�L <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURED ADDITION STAIRS .x .. 9 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPING UNIT O BUNKHOUSE 0 59.692(1V)GAZEBO Cl DECK W ._ <br /> STRUCTURE/ADDITION USE: �a s <br /> (Home/Cabin; Commer/ciiaall Business; Bedroom; Deck; etc.) z <br /> BUILDING CONTRACTOR: <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN B yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAN O <br /> WILL BE RETURNED. C o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 'f I n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnsl <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). v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S N Z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK P <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. w' O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCEty <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. U.J <br /> S. INDICATE IF A WALKOUT BASEMENT IS Pl '!NED AND SHOW AREAS TO BE GRADED OR F?'-LED. <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. W o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. I I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 4-1 <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. r] <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. R Z O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. <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 /> 7y >nmao -o <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge n A ^ a <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information H <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this information I ^p 0a a5 <br /> m N = w <br /> am providing will be refiled upon by the County of Burnett Wisconsin in determining whether to 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 m - <br /> permit county officials charged with administrating co ordinances or other authorized person to have access to the above- C-'n a <br /> described premises at any reasonable time for the p of Inspection. v R N <br /> p <br /> OWNER'S SIGNATURE ' D �V y ~ <br /> , n <br /> (date) <br /> ZONING ADMINISTRATOR c S ' Z <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE i <br /> O: N: <br /> H p W yyN V1 <br /> v�U C In�N1�`0 <br /> w <br /> d <br />