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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS g <br /> y 913— %G6 9vsv ' a <br /> OWNERQ /w L(Na• TELEPHONE GSA"7SY"��J�O e O <br /> MAILING ADDRESS GS7/ <br /> /Y/)c AUF S 6 r,, Ce&lc <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION k/ <br /> SINGLE FAMILY DWELLING L GARAGE/ACCESSORY STRUCTURE K ADDITION L STAIRS ❑ <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING L CAMPING UNIT L BUNKHOUSE L 59.692(1V)GAZEBO L DECK L <br /> STRUCTURE/ADDITION USE: sTbnif FTE �O�/fA�C <br /> z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: StZ/- <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT FLANS n <br /> WILL BE RETURNED. p <br /> z < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 <br /> � a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. rnn <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW ti <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, t� v <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILKNG(S) <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. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d c <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 /> .i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. - Z <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. <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. <br /> 6. <br /> >f1W ODO <br /> 7. <br /> m me P. <br /> � n 9 Fire <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowlkdge <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information c <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this information I ,'d< <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 In rmatlon I am providing In this application. I agree to Fr <br /> permit county officials charged wit Istrating county Inances r other authorized person to have access to the above- o "' <br /> described remises at an re able�te r t >P yp rpoWfinson. w 2 C� h v, m y <br /> OWNER'S SIGNATURE <br /> (date) B c 'i71 <br /> ZONING ADMINISTRA R <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w <br /> oU <br />