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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS . 9 <br /> 03 <br /> OWNER L[, I N ,4- AIy) f C Cy Y rl Q N --TELEPHONE <br /> MAILING ADDRESS 40 q 15 ' I Il Jt `Cc1 S+ '�1 �INC� H- 1 in ��1I <br /> c C/" <br /> PROPERTY ADDRESS R <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE ADDITION STAIRS ' .°�. <br /> FILLING/GRADING 1 ,,CA(M�P�I,NG UNIT BUNKHOUSE 59.692(1V)GAZEBO DECK <br /> STRUCTURE/ADDITION USE: S I'nG l(� <br /> n(�F e/Cabm; Comore Tal Business; Bedrooih; Deck; etc.) S' <br /> 0 <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 %X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS „y <br /> WILL BE RETURNED. C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW do o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BU4.DING(S)TO ALL LOT LINES, (B) BUILDINGS) 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. N19 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (OF), AND ALL DISTANCES N 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. d J c O <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 /> H � <br /> NOTE: BUILDING/ST'RUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C <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. n �� <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 /> ;f a rI w a W v <br /> 2. w <br /> I declare that this application(Including any aocompanrying schedule)has been examined by me and to the best of my knowledge C w <br /> and belief K Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained In this application(Including any accompanying sdhadule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further adapt all ,. rA H Vl rNi <br /> liability that may be a result of the County of Bumett relying on this Information I am providing In this application. I agree to n U g U tt" <br /> permit county officals charged with adminBbatbg county ordinances or other authorimd person to have access to the above- S f1 <br /> described premises at any �°nab time floyrn\t/he�purpose of I spection. /� bf v,s Y <br /> OWNERS SIGNATURE_ l o <br /> f (date) y, ; a S g 5 <br /> ZONING ADMINISTRATOR <br /> dlQt <br /> ( I� 3 : t <br /> TOWNSHIP PERMITS MAY BE REQUIRED n i <br /> THIS Pr <br /> IT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 U o <br /> �iw + 4 LL4-K t, n-�rLf tc-d 40 M-0-4h�j r� --('7 <br />