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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administri for o <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER / � £� TELEPHONE <br /> MAILING ADDRESS `/ o <br /> Ali S 33 vl E <br /> PROPERTY ADDRESS <br /> OS` o u1 /3J . <br /> SG S3 / ' <br /> s O <br /> LEGAL DESCRIPTION *, y7 5 V T 1/ n ( <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION STAIRS 0 5- <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK Cl .. <br /> STRUCTURE/ADDITION USE: r7 --57/I D� CJ/c/GC( z <br /> (Home/Cabin: r.......,.,miai R. °adlm,-.,..• n„eecly etCJ� <br /> BUILDING CONTRACTOR: 446MI ��� COiCJ$'/7llJf/.d� _�/�.i! — L <br /> _ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT P NS +f y <br /> WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) R�a1 2. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Iv a <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). ) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDIN (S) [7 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 3 <br /> (OHWM)OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTAN ES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �? E <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,T E ° <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. .^. <br /> ..l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WH N <br /> NEEDED. I .91 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:( _�' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. f 1 1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. IN <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE OA LY. <br /> NOT TO BE USED FOR HUMAN HABITATION. £ <br /> 6. <br /> R � P3 R g � <br /> 7. a9 BW Lr'.5 <br /> w <br /> I declare that thisapplication(Indudinq any accompanying schedule)has been examined by me and m th best of my knowled e <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accurace of all Information e <br /> contalned In this application(Including any accompanying schedule)and I further declare that I recognize that this Information Y <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether In Issue a permit I further accept ill <br /> liability that may be a result of the County of Burnett refying on this Information I am providing in this appllration. I agree to n 8 8 <br /> permit county officials charged w dministrating county o finances or other authorized person to 11 a-"w to the above- 6 <br /> described premises at any rea le time for the pu f Inspection. .fn(i� t o t e abo m n y^ r y <br /> ^ � .. <br /> SIGN HERE R <br /> (signature o own /o�r}build"contractor) °= a� g <br /> ZONING ADMINISTRATOR <br /> -^ o <br /> TOWNSHIP PERMITS MAY BE REQUIRED NOV 1-5 LV N' N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE O SUANCE <br /> Perm i-� 4 1e--f- Geiald bUNTT Cou T-3' - <br /> 0� <br /> MMNG <br />