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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS <br /> z � <br /> OWNERTO� Pv �L-(�N� TELEPHONE6 Z 1 - 6 <br /> MAILING ADDRESS / C -7�` <br /> PROPERTY ADDRESS LOQ A� M V/`— LAN �CE Q h—r of-F. > <br /> LEGAL DESCRIPTION NVMe.�eI ,f e� <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE ADDITIONCI STAIRS 0 o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPING UNIT HO 0 BUNK <br /> SE ❑ 59..6/92(1V)GAZEBO 0y DECK❑ <br /> STRUCTURE/ADDITION USE: �+' '~ 6 AMI oN /A 0 oTA 8,n <br /> (Home/Cabin; Commercial Busi less; Bedroom; ecl_ <br /> BUILDING CONTRACTOR: Tb b /�R��'Pfr' p <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS qZ <br /> WILL BE RETURNED. F c <br /> O <br /> DIRECTIONS FOR PLOT PLAN 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 rp <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m s <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 3 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK e <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. c v, Z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <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 /> .j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> r Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' a a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <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 <br /> SETBACK AREA. l(v5�,ll <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> yyanEm �a e <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge g 2 , !� j j :.i <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 1 <br /> am providing will be relied upon by the County of Burnett Wisocnsin 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 g " <br /> permit county officials char d with adml ating county ordinances or other authorized person to have access to the above- < (� <br /> described premises at any sonable for the purpose of Inspection. <br /> OWNER'S SIGNATURE <br /> ZONING ADMINIST R L <br /> n <br /> TOWNSHIP PERMITS MAY BE REQUIRED »' ^ <br /> v V w u N H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE $ U ^ <br /> �P�rn l d lQ I �l clued ip b y Jbh Srut,53 I I-9 -Ob <br />