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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n c <br /> APPLICATION FOR LAND USE PERMITS . <br /> = n <br /> OWNERC\,/K7 /1 T EP NE <br /> �` <br /> L11XVt 1.0. �"� fo a ✓d'� )76t4rv% E t�0� a J <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS LD f ( `TZ ._� 0 <br /> LEGAL DESCRIPTION y <br /> 5 <br /> SINGLE FAMILY DWELLING 0 GARAGE/A�CESSORY STRUCTUREY ADDITION O STAIR O o <br /> TYPE OF PERMrr(S): o <br /> FILLING/GRADING�0 CAMPING UNIT ❑ BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 <br /> STRUCTURE/ADDITION USE: D tLe,k Srvt.l 2vub�9 :a� hfe.£W— <br /> (Home/Cabin; Commercial.Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Wh tLe¢rS <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF O APER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> N <br /> WILL BE RETURNED. O '� <br /> � o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) lQA'I h Q �d,�f�� % 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN M a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING B ILDINC —"-' �'" C! For <br /> BUILDINGS/STRUCTUR(S(NB), INCLUDING DECKS, PORCHE -7 +10 C A [� <br /> 1 v <br /> AND INDICATE NORTH (N). <br /> 1�0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILT CC-- >IN (S) n <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREM�NT(S) ..7t YQ�t1 W, <br /> ��g7Z K E <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLANDII AREAS, I N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST) -AN ES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. we p <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHIT CT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE _ f W <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1� <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 /> r Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION S RESTRICTED ALONG SHORELINE. n Qc) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. R <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETEC.,ALLOWED WITHIN THE REQUIRED WATER ` <br /> SETBACK AREA. iI v <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE Of LY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> z Xf�nm g <br /> 7. A � gas <br /> I declare that this application(Including any accompanying schedule)h s been examined by me and to the best of my knowled e Z y <br /> and belief It Is true,correct and complete. I acknowledge that I am nslble for the detail and accuracy of all Information e F <br /> contained In this application(including any accompanying schedule)a I further declare tlwt I recognize that this Information I ^ �„Y <br /> am providing will be relled upon by the County of Burnett Wisconsin In atartnining whatha Oa Issue a permit I further accept all c N v.M^' <br /> liability that may be a result of the County of Burnett relying on this In rmabon I am providing In this application. I agree to n 0�^8 '" 8 to <br /> permit county officials charged w*administrati w ordlnanas other authorized person ha access to the above- e <br /> described premises at any re le time for p of inspxnop. m n w w y <br /> OWNER'S SIGNATURE o n ' g �a21i <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MA BE REQUIRED <br /> THI RMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE CN S N U o <br />