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Burnett County 7410 County Road K, No. 102, Siren, WI 54672 Office of Zoning Admini trator v — Z <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 = <br /> o <br /> OWNERk/ ^j_a/. 1414�/ TELEPHONE <br /> l / I n l� <br /> MAILING ADDRESS Ale Yh I ,C.LUC IIS <br /> S <br /> PROPERTY ADDRESS /V7 /) L ✓l/ <br /> n <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ST IRS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DE--K)( <br /> STRUCTURE/ADDITION USE: ibecLz <br /> /(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c ° <br /> BUILDING CONTRACTOR: <br /> W <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOI PLANS +f y <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 17^ o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ^r n <br /> BUILDINGS/STRUCTURES (N8), 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) BUIL ING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAR 'ice �i 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. car Oq <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DIS NCESc <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN <br /> NEEDED. 7z�, �. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n 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 <br /> SETBACK AREA. \ <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> TF >r:e X.c- 7 <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my know edge 3 c <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the de[all and accuracy of all informatip ±_' y <br /> contained in this application(including any accompanying schedule)and I further declare that[recognize that this informati n I <br /> _ a <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a Permit I further acc pt all o <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the abov <br /> described premises at any reasonable time for the purpose of Inspection, c C1 K.T_ D <br /> OWNER'S SIGNATURE e Sa 2 <br /> �� /—' (date) io, :. e _ .zf <br /> ZONING ADMINISTRATOR V'�) /— r7 <br /> C < : <br /> vl <br /> TOWNSHIP PERMITS MAY BE REQUIRED ? p ' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br />