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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 /> OWNER <br /> DRY <br /> ib � &RG ( jqx/ TELEPHONE / '� 7 pl 901/0 a <br /> MAILING ADDRESS I/ •1 -AST TSLAAlb P Vr- m p l s 1/h ou 51/O vl O <br /> PROPERTY ADDRESS <br /> ACiVLcCoM La.reT/Qr/W�v a <br /> LEGAL DESCRIPTION L-O+ � p <br /> J G <br /> S2 S PPrtJG GREEW 0-0 199 Ty L10 1/A tll�ti s <br /> TYPE OF PERMIT(S): <br /> DWELLINU/BUILDINUA GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS C <br /> L ' <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZESO 0 DECK C O <br /> STRUCTURE/ADDITION USE: -d/.• � • <br /> (Home/ abin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: O W Al <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tr7f d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW .m^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) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK0 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES -�^. C7' 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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. ' O� <br /> -I I <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 /> 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 F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. R <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. <br /> � � a� aoaoro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge R - H <br /> and belief It Is We,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 v ? <br /> aI further accept all <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 /> providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit o 8 .ror. <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o <br /> described premises at any reasonable time for the purpose of inspection. n <br /> 3 d o' - > <br /> SIGN HERE ` / O � F�' C p <br /> (s gnat a of o ner or building contractor) date <br /> ( � e a 2 <br /> ) ao d �. <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEO g ;o <br /> Ly <br />