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Burnett County 7410 County Road K, No. 102; Siren, WI 54872 Office of Zoning Adm nistrator z <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER \ � <br /> �7 V TELEPHONE /,!:51_ 77O <br /> v <br /> MAILING ADDRESS S 09 <br /> '7578 �- �ov1h t�. e N !4-. Paoli, <br /> PROPERTY ADDRESS -?(g nJ y pQ1 <br /> �• Q <br /> CI / �J <br /> LEGAL DESCRIPTION <br /> 0 <br /> SINGLE FAMILY DWELLING ❑ GARA E/ACCESSORY STRUCTURE ADDITION ❑ TAIRS ❑ o_ <br /> TYPE OF PERMIT(S): / E+ <br /> FILLING/GRADING B' CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ ECK ❑ ,.02 <br /> STRUCTURE/ADDITION USE: f-0. '— I� <br /> y� (Home/Cabui omm «ial Business; Bedroom; Deck; etc.) c p <br /> BUILDING CONTRACTOR: ,c—,c5 J ji--� <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHE OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PL T PLANS I�`'1�J <br /> n <br /> WILL BE RETURNED. O 3 <br /> a R. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (gRIAL OR TOP VIEW) R. <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 y <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUI DING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASL REMENT(S)TO THE ORDINARY HIGH WATER M K pJJ g <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETL AND AREAS,AND (D) LOT DIMENSIONS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DI TANCES y o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, E .,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE 0 NER. - <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE y <br /> NEEDED. WHEN DON <br /> THIS PERMIT IS SUB1ECr TO ALL CONDITIONS LISTED BELOW: I�- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATI DN IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 9 �1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATE I <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAG <br /> 6. .ONLYO <br /> NOT TO BE USED FOR HUMAN HABITATION. C <br /> 7. <br /> I declare that Mdudi <br /> Is application(inng any accompanying schedul )has been examined by me and to the best of my kno ledge <br /> and belief it Is true,correct and complete. I acknowledge that I a responsible for the detail a <br /> contained in this application(including any accompanying schedule and I further declare Mnd accuracy of all Informati nat I recognize that this informs ion I E ' y! D <br /> am providing will be relied upon by the County of Burnett Wisconsl In determining whether to Issue a permit. I further ac ept all ^w`='�^w 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 <br /> permit county officials charged with administrating county ordinanc ts or other authorized person to have access to the abo e- o U'{� <br /> described premises at any reasonable time a purpose f I p on. n' n <br /> 3 Ono = Y <br /> OWNER'S SIGNATURE <br /> ne a n Z <br /> (date) y : a o > <br /> ZONING ADMINISTRATORyr'1 <br /> TOWNSHIP PERMITSAY BE REQUIRED H' <br /> THIS PERMIT SHALL EXPIRE ONE EAR FROM DATE OF ISSUANCE <br /> �ei�iyr�� 1ef I�r Prcke via by 6&7 Vah�u�lder <br />