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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g z <br /> APPLICATION FOR LAND USE PERMITS <br /> N N <br /> OWNER /—.' /I1.) I L '�/ — TELEPHONE <br /> �_6S�—� 728-7004MAILING ADDRESS 78S'� .YJ/y/C',2,S�T •"OOH`°"`/I`�j AI SS � <br /> PROPERTY ADDRESS //Z/,f/7 �ze-e 4DA7 � <br /> LEGAL DESCRIPTION `1// ' O S - 0' to <br /> Vo)/AGe,f �b�R6 Lheekpn-rH�i of / NE <br /> DW LING/BUILDING❑ GARA ACCESSORY STRLCTURE ADDIYION ❑ STAIRS ❑ I^ v <br /> TYPE OF PERMIT(S): rl <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE /❑/ 59.692(IV)GAZEBO DECK❑ C <br /> �� /�D/s1 S/ �ffT o z <br /> STRUCTURE/ADDITION USE: 6�,aiebinimmerc(Home �inJess; Bedroom, D/eck, etc.) i <br /> BUILDING CONTRACTOR: J7 eR.✓k/N�f e�2. 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Xh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. o ;; <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n w' .� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). TO ALL LOT I e <br /> 3 TSHOW DIMENSIONS IN FEET O CENTERLINE OF ROAD, O BUILD NG EASUREMENTT(S)O THE F THE FOLLOWING: (A) )ORDINARY HH W TE)R MA KINGS) Z <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. �0 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> � 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE i <br /> XJ <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 WHEN I$ m 0NEEDED. ` o <br /> t rt <br /> ? W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � <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. 3 I3 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Q I 0 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. n R g <br /> 6. g n RRA:_ 7p <br /> � 13 3 <br /> 7. 9 2 a°a ll a°^ <br /> 1 decare that MIs aDDllcatlon(Indudlnq any accomwledge schedule)has been examined try me and u Me bat of my knowledge 2 H Y' a <br /> and belief It is true,correct and complete• I acknowledge that I am responsible for the detail and accuracy of all is Information <br /> nfer ati ? «= J N <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this aaGePt all <br /> am providing will be railed upon DY County of Burnett Wisconsin In determining whether Co issue a Pegrille to <br /> Is ° <br /> liability that may be a result of the County of Bumett relying on this information I am providI in s spillaaas . the above- n <br /> S 5Q <br /> permit County officials charged with administrating County ordinances or other authorized perso a <br /> B <br /> described prem sat any nasonabM time for the purposeof inspection. <br /> a <br /> C! / ,2006 0 0 <br /> = a _ <br /> SIGN HERE1•�tufA`� ata) <br /> (signature of owner or building contrattnr) =�, <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED w g N N o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> 4 E 1111 I��✓ ��-�C��o <br /> I � I <br />