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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 office of Zoning Administrator <br /> N Z <br /> APPLICATION FOR LAND USE PERMITS 0 <br /> OWNER A TELEPHONE 15- /31 <br /> MAILING ADDRESSO / SDI <br /> Cp r f j& ^� �j,pp 3 e-32L1,11- . J <br /> PROPERTY ADDRESS ? p V y v /�j"Z/c <br /> K G 7 <br /> LEGAL DESCRIPTION S oq T`q C) � R W �^� C S WI V 1 t C <br /> ea SINGLE FAMILY DWELLING n snnIT10N ❑ STAIRS O IS g <br /> �[ WI+AULIA��c"" ' � R <br /> TYPE OF PERMTT(S): 4 <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(IV)GA2EB0 O DECK O <br /> ITP 0 <br /> STRUCTURE/ADDITION USE: 4 p <br /> (Home/Cabin; Commercial Business, Bedroom, Deck, etc) I <br /> Llsd a.�O2ngi Ll,c. � <br /> BUILDING CONTRACTOR:_ V aF - <br /> 2�^12q STk)E 2A) 5 )2�1 . Wj-,j � <br /> n <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya XI1 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE ijLOT PLAN F < 00 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARLAL OR TOP VIEW) <br /> f <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TURES SCALE. <br /> �p (� <br /> 2 SHOW THE LOCATION AND <br /> EOF ALL IB <br /> LDINGS/STRUCTURES (NB) INCLUDING DEC S <br /> BU[ PORCHES AND OT ER STRUCTU ES, N <br /> N s <br /> AND INDICATE NORTH (N). I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BI.IILD)NG(S) I� 9-) e <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER 1M,ARK J e <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. J o <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. = J O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHC W AREAS TO BE GRADED OR FILLgD. - <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR,'ETC.,THE - d <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINWSTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN41 <br /> NEEDED. <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n x <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHO RELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMME D. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER I <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. E <br /> NOT TO BE USED FOR HUMAN HABITATION. ^ 7C R >Y-Y <br /> 6. n w3 ai <br /> I declare that this appiicabod(including any accompanying schedule)tus been examined by a and accuracynd the best of y knowledge C =;^ ; -1 <br /> cand ontainledf iri ths aopit is true,�atian( ciu0 ngeany accomDanyanq scned e)and 1 furtheredecla a thatI rrecoq ice that thill s formation I '^ <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I furter accept all <br /> oe .gc. = r <br /> liability that may be a result of the County of Burnett relying on this information 1 am providing In this application. I agree to <br /> permit county ofriciais charged with administrating county or <br /> or other authorized person m have access to a above- ^ . IF; <br /> described premises at any reasonable time b se lnsDen <br /> Rn' gq <br /> g� gk'2 <br /> OWNER'S SIGNATURE^ <br /> y (dal ) <br /> -Iles <br /> ZONING ADMINISTRATOR q <br /> N' M <br /> TOWNSHIP PERMITS MAY BE REQUIRED N €N M M <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> bV 60/g6 <br />