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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS a <br /> y <br /> OWNER Y7 Lv; TELEPHONE�1 �^ 0. r _ � �3 <br /> C� O n O �Y <br /> MAILING ADDRESS <br /> 1��, � �0 �.�)e� S t�, fin➢ . �`{ F°(3 � o <br /> PROPERTY ADDRESS <br /> + 1 j I <br /> LE L E C PTI N } �(p U01 �. P.a�e CJJi,IdU'I IN• ° w <br /> 'n� ffI?N P <br /> f DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): k <br /> FILLING/GRADING ❑ CAMPIIN�G UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ n <br /> STRUCTURE/ADDITION USE: I- •oe_/Cf�'h` z <br /> —1 Home/C in; Commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: �J d'�rel �iQ 11lJS, ib 6o,, (' <br /> 3 6 T <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS hf w OC <br /> WILL BE RETURNED. C <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) R (/1 <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> m <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, to w <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) d <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 3 <br /> ,R <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES ° P <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Ll W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE G. <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 <br /> NEEDED. _ O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <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. n GU <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. b' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER UV <br /> SETBACK AREA. (N <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. £ <br /> 6. <br /> ^ gyaaoro <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge w m y <br /> and belief it 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 schedule)and I further declare that I recognize that this Information I <br /> am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all c n <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o d <br /> descnbed premis at any reasons a tim for the purpose of Inspection. m S y <br /> SIGN HERE OCA J� 0)c c m <br /> (signature of owner or building contractor) (date) > <br /> ZONING ADMINITO 1001 man <br /> U V: <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> LL� �er�y PGt�/its �6 i-a� <br />