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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Of a of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS r: y cwi, <br /> OWNER �r rs <br /> �7RAiv f ccJNsEnJ 7i5- 4/63- <br /> TELEPHONE �3© <br /> O <br /> MAILING ADDRESS �-L , TTIQ <br /> PROPERTY ADDRESS����/ �a(ES �/M76�•J9JQ r�C�� C o <br /> LEGAL DESCRIPTION �LL) N E O'T39&I <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION-DECK❑ GARAGE/ACCESSOTY STRUCTURE ❑ <br /> BUNKHOUSE 0 59.692(1V)GAZESO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 { <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION El COMMERCIAL ACCESSORY STRUCTURE ❑ _S <br /> STRUCTURE/ADDITION USE: C I N ^ 7 o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.)( <br /> BUILDING CONTRACTOR: N,d an <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLAT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW lmi 'O o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, o v <br /> AND INDICATE NORTH (N). o tv w o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) $ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o w <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND(D) LOT DIMENSIONS. 4� d <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. ' m - <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Uj <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. d <br /> NOTE: BUIL.DING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN W <br /> NEEDED. p -e <br /> w Ld <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -9 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER p (— <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGEISTORAGE ONLY. p <br /> NOT O BE USED FOR HUMAN HABITATION. <br /> 6, VrIv/ D/L c2 - <br /> 7. 0 � ' o= > <br /> 6 <br /> C <br /> I declare that this appllptlon(Including any accompanying scliedula)has been examined by me and to the best of my R e „ p $ <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all . m I-8 I- <br /> Information contained In this application(including any accompanying sdudule)and I fuller declare that I recognize that this <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I w <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this Fr - 69`^ <br /> w '0 <br /> application. I agree to permit county officials charged with adminlsbstlng county ordinances or other authorized parson to have e <br /> access to the above-desa7bed Premises at arty reasonable ttb purpose of Inspection.. 5� 9 8 8 g888���8 <br /> OWNER'S SIGNATURE f/ a w *! C <br /> (date) <br /> 3 S': owSts7 <br /> ZONING ADMINISTRATOR � ✓� � o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS P IT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE tiE N N <br /> f�frmif I e �✓ �otcted Ftp h� EsrJ� )scn id-lp-1 I <br />