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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERTELEPHONE c c. <br /> Olirn�ia� AN:CJ �CGf� 95a - 9�b'3 /79 - <br /> MAILING ADDRESSJ <br /> 53b7 /4211oe,g ,gv� ,, l�/in�I /�I,eJ ssya� o <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION LOT GF csyvl U 3 FC,A 6D✓ 6o4 o J <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE 0 ADDITION C STAIRS ❑ o <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING 0 CAMPIG UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK CI <br /> STRUCTURE/ADDITION USE: Om�/C!Gv F0"�j <br /> Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) („ <br /> BUILDING CONTRACTOR: ✓�-e� /\/u T? C_ )n STf tit C T'/bI�-� W <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. O 3 J <br /> M <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW n <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). G <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <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 DISTANCES ?. J <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. oa <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 _ 3 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I <br /> H <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN � <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 7- <br /> 1. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. � <br /> z o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n 3 <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. ro 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> >d ao > 07 <br /> 3 = � t t7 <br /> 7. x � �,� <br /> T�wu <br /> I declare that this application (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 o a ? <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this infonnatlon I ,'�� C N 7 <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all ` N— w „ o <br /> � uuo <br /> liability that may be a result of the County of Burnett retying on this Information I am providing in this application. I agree to � �„o� [' <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- � <br /> described premises at any reasonable time for the purpose of inspection. T1 p v, = _ 7 <br /> OWNER'S SIGNATURE <br /> (date) <br /> dim �l/�/1c�an � v <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v o N <br />