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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS <br /> i2y <br /> O_ G <br /> OWNER �� � TELEPHONE <br /> MAILING ADDRESS 4 V p ad h u/S I L(� ✓L� ((/J�_/�y� �, SJ�— �,� 1 <br /> PROPERTY ADDRESS <br /> a <br /> LEGAL DESCRIPTION LO 1 V15 <br /> „// Cy <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STA RS ❑ o 5 <br /> ,o <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BBU�NKHOUSE ❑ 59.692(1V)GAZEBO ❑ DE K O (� <br /> STRUCTURE/ADDITION USE: Gar 4 C� W Q t I GcA e J 5'C/1 CEiV /-/occ f e z <br /> (Home/Cabin; Comrriencial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Car $O h v S �r/l/C - <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS y <br /> WILL BE RETURNED. A < <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) — <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ^ tv <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW c <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) BUILD NG(S) p I 3 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Y ,e <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTI NCES o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' Q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE �r <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> � � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE V HEN n <br /> NEEDED. <br /> THIS PERMIT IS SUB3ECT TO ALL CONDITIONS LISTED BELOW: (:) \ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. a O <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. ' <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER -� <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> �. RS � Qr 3'2f�4c/Ts wr �l. Crag CoAAC"r 6 -/-o7 � � ANmga <br /> 985. <br /> I declare that this application(induding any accompanying schedule)has been examined by me and to the best of my knowl dge , <br /> and belief it Is true,oonect and complete. I acknowledge that I am responsible for the detail and accuracy of all Information 9 e <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this InformatIc n I <br /> am providing will be relled upon by the County of Burnett Wlscoreln In determining whether to Issue a permit. I further acce t 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 lz o <br /> permit county officials charged with administrating county ordinances or other authorized person to have access bD the abo - 8 f1 <br /> described premises at any reasona me for the purpose Of In n. <br /> OWNER'S SIGNATURE x <br /> ZONING ADMINISTRATOR ~ ^ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> H: H: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v U 8 N o <br />