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c n Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> I 1 1 I " GS 1- 33 t' 74115 <br /> OWNER �Ft�h=-. `r. Ili�lc TELEPHONE yYJZ O . <br /> � v F <br /> MAILING ADDRESS <br /> 1-7 G W I G M Sj I z Z <br /> d <br /> a <br /> PROPERTY ADDRESS <br /> cLL 1 1 1 1 <br /> LEGAL DESCRIPTION ( r Sw/N t' S 1-1 T4•I 4 11,' 14W o <br /> Lvt 2✓ GJ'� �� � Zi� ) if (3aJ L�� y <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZESO 0 DECK 0 .o <br /> 11II r ° <br /> STRUCTURE/ADDITION USE: LJ <br /> (Home/Cabin; Commercial Business; Bedroom; D ck; etc.) '-j (S Z 3 b 4&44z <br /> o <br /> BUILDING CONTRACTOR: w( 6�54 ^ v�.G -IIS - 3�'- �"G,�•,3 (J <br /> IoS t ��s T A,'L C', I� Iz�, 1* Sq V b <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. C c <br /> 0 <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C m <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, t•i 'O B <br /> AND INDICATE NORTH (N). EI <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) N I Y <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES 0 ( SU <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y <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. £ _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r l <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. B z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER a <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. F <br /> ^ <br /> I declare that this application(including ;0 >�moaoroudinq any accompanying schedule)has been examined by me and to the best of my knowledge s <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ,°°r ^ o a y jr <br /> contained In this application including any accompanying schedule and I further declare that I recognize that this Information I <br /> PP ( Y9 ) 9 3p �aac ? w <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all ^.vA <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 of rials charged with administrating county ordinances or other authorized person to have amess to the above- w ;q <br /> described premises at any reasongbl time for a purpose of Inspection. Q N='w N S .bp <br /> / �Ng � t <br /> OWNER'S SIGNATURE to <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Vl' y <br /> W OHN tHn <br />