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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Adminis rator R z <br /> APPLICATION FOR LAND USE PERMITS a . <br /> � N <br /> OWNER a <br /> TELEPHONE <br /> MAILING ADDRESS 3C-')Sb LeV(n hi-) Ave- /V Shwe view <br /> �� O <br /> � E <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION M J <br /> < V1 <br /> SINGLE FAMILY <br /> TYPE OF PERMIT(S): DWELLING GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 ST IRS 0 C o <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE O 59.692(1V)GAZEBO 0 DE K 0 CIr <br /> STRUCTURE/ADDITION USE: ffiw � ZI s <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) e o <br /> BUILDING CONTRACTOR: <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. SJ <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING',BUILDINGS/STRUCTURES (EB)AND ALL NEW �^- R <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECK$, PORCHES AND OTHER STRUCTURES, :*1 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILD NG(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAR <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 DIST NCES u, d o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. _ Q <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. O <br /> NOTE: NEEDED.BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN rum,;' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: /W IC t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z -� <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 "j) <br /> SETBACK AREA. O <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> � >vc ?�. DF t�rl <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ofmy know) dge y c n <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information $ p a <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this informati I ' Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further acce t atl ^in y'W w 11 7 <br /> liability that may be a result of the County of Burnett relying on this Igfortnatlon am provkllnq In MIs application. I agree n O N S r <br /> permit county officials charged with administrating county ordinances �'r of r Monzed person m have access to Me above a�: n <br /> described premises at any reasonable time Por Me purpo . m o `a _ <br /> S <br /> OWNER'S SIGNATU / e 96 [so <br /> 0 <br /> � (date) a y : <br /> � <br /> ZONING ADMINISTRATOR J/a) /L I a <br /> TOWNSHIP PERMITS MAY BE REQUIRED v ` <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE M 8 N a <br /> �m(-h I Q f {er pe,LPGf_ k�0 bLy �Gtrres1L4 C) <br />