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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 PERMITSRE <br /> € <br /> s <br /> OWNER / I ®� fad n TELEPHONETrz—N <br /> MAILING ADDRESS J a( 7 7 U) <br /> PROPERTY ADDRESS <br /> G rl 3ip �( <br /> 7 IL, q x <br /> LEGAL DESCRIPTION 0 <br /> ansm ✓ 8 � 3 g_ <br /> a <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS 0 0 <br /> TYPE OF PERMIT(S): ,g <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59m692(IV)GAZEBO 0 DECK' <br /> STRUCTURE/ADDITION USE: deZ <br /> t ./(Ho a/Cabin; Commercial Bu mess; Bedr.00�m.(/• Deck; etc.) e P <br /> BUILDING CONTRACTOR: IK p P tLe (y�'r �" I� \ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY 1NCOM E OR ILLEGIBLE PLOT PLANS r1 <br /> WILL BE RETURNED. ; <br /> x � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARL1L OR TOP VIEW) C L <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r <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). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) r1 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 3 <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 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. <br /> y <br /> NOTE: NG/STRURURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN -7t-I� <br /> NEEDS I <br /> NEEDED. "Lj� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. L' _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c1 s <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I (� <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 /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ofmy knowledge Y Z C R <br /> and belief R 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 'o e ` i <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I 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 x <br /> permit county officials charged with administrating county ordinances or other authorize Mon m have access to the above- a <br /> described premises at any reasonable time for the puAsoct on. <br /> OWNER'S SIGNATURE <br /> It e ^ S 2 <br /> I < (d ) Z fie <br /> 6 <br /> 5'z1 <br /> ZONING ADMINISTRATOR <br /> 4 ` Eii <br /> TOWNSHIP PERMITS MAY BE REQUIRED = <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE M 8 M M <br />