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Wort 4 SOS I- b(ba- 003 <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c z <br /> APPLICATION FOR LAND USE PERMITS 0. <br /> A'no ld m c NGmur� y <br /> OWNER i 51" <br /> / <br /> 1,TELEPHONE <br /> MAILING ADDRESS <br /> -� <br /> con �o <br /> PROPERTY ADDRESS a,f <br /> 615010 In <br /> C (� ,�,1I <br /> LEGAL DESCRIPTION r L/ /L), S t/C°. S 0 -/ E ,oZ nU Sof <br /> " o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURADDITION [03 STAIRS ❑ <br /> TYPE OF PERMIT(S): t v <br /> FILLING/GRADING [ICAMPING UNIT 11BUNKHOUSE'9I 59. 92(1V)GAZEBO ❑ DECK ❑ n <br /> STRUCTURE/ADDITION USE: _ _ _-- <br /> _ __ _ __ '3 7 <br /> 0 <br /> /C.a`bin; Commercial B,u's/ilne`ss; Bedroom; Deck; etc.) o_ <br /> BUILDING CONTRACTOR: <br /> b <br /> o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. O <br /> z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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). -7 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) r) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. IN <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES r '� <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c7 o <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. 7 Q' <br /> o , <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. M a <br /> o m <br /> C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> w <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. " vl <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER J <br /> SETBACK AREA. }v2 <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION__V�}Q—,o ' 1 ��I we W% 1,( n0+ <br /> 6. .N-t \\ <br /> IW � <br /> 7. , � /- X30x 40 ��a o(\ n m mI declare[hat plicatlbn(Including 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 c <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I o ? a <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a I . I -w -N o N o 7 <br /> liability that may be a result of the County of Burnett relying on this Information I am providing I It o r <br /> permit county officials charged with administretinq county ordinances or oNer authorized persgrt, �hax hC-a I �P N N .. <br /> described premises ata y reasonable time for Me purpose of InspeRlon. I IUI I ,I a� v, _ <br /> �a � � <br /> SIGN HERE I J owner <br /> Or `L/'I//1 I � <br /> Ignatu�reof�ow'ner oris"IlAing contractor) ruy ­(date) � � i � �o^ a <br /> ZONING ADMINISTRATOR I M 1' I�I11G( BURNETT �� Nom` = ° ° � <br /> p <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Pe"-r 4 (_ p �d q by Mc Ab illa3- q-a y e <br />