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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 0 <br /> APPLICATION FOR LAND USE PERMITS a N <br /> OWNER ATELEPHONE b <br /> MAILING ADDRESS c 4 9 Cb-Q 4 e�� � r <br /> PROPERTY ADDRESS p O 1 <br /> cSC1<11 Q O <br /> LEGAL DESCRIPTION c -� <br /> C . <br /> 4 <br /> TYPE OF PERMIT(S): SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ <br /> FILLING/GRADINZEI nCA//MPING UNIT❑ BUNKHOUSE El59.692(IV)GAZEBO ❑ DECK K <br /> STRUCTURE/ADDITION USE: e7 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) I z <br /> BUILDING CONTRACTOR: b Uc7 <br /> pA PLOT PLAN MUST BE PROVIDED ON AN 8 Sh X11 SHEETOF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT O <br /> WILL BE RETURNED. PLANSyj c f) p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) A I �- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n c <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, '9 A c <br /> AND INDICATE NORTH (N). a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o o <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 tl0 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. /v <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE .. N <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. .-I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. � <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � O <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n Cl) O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER A c C <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I' <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. W U�S4 ha e 4- 5?-F6&0k aY 25r fywo .selohc 7L r)/e A-O rr) U) <br /> 7. S�*ttiC h w e,. <br /> I declare that this application(Including any accompanying schedule)has been a amined by me and M the bestof my knowledge >n E > tl -0 <br /> and belief It Is true,correct and complete. I acknowledge MM <br /> at I am responsible for e detail and accuracy of all Information R ^ g a Sr <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I 5 2 B <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept 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 to <br /> permit county officials charged with atlminlstrating county orAnanc)o or other authorized person to have access to the above- $ c y <br /> described premises at any reason le time for the p ose f n /^T„• m H y iA«8,y <br /> OWNER'S SIGNATURE <br /> n s Y <br /> �^ (dare) <br /> n <br /> -TI <br /> ZONING s ac) o <br /> ZONING ADMINISTRATOR. Z <br /> o ro <br /> [Ck) ae - 5 KyTOWNSHIP PERMITS MAY BE REQUIRED °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> l e i✓ rna i t ed fv Fav,"r-v M4.��. L��l/`'� <br /> H: M: <br /> �/ W N gHNVyi <br /> tWi i� O <br /> 3-a <br />