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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 W <br /> OWNEROV �g' y CIQc,� au. �. TELEPHONE /_3—S �- 6�� Gt::> <br /> / ] � H <br /> MAILING ADDRESS <br /> T�' 4 ,(� �µ ✓/� /-Tr� ..11� tel/' 1� �pp���"'!l1444 ,n STI" <br /> PR05E7 A 2ESS /.'c.LC R Wi y rl GI l l Y �Cc r.T2.T I ^". �R 1? G✓G � <br /> 0 6 4'vl ff" 1 41 CD <br /> LEGA DESCRIPTION Ta✓ <br /> 7 �,ra IE- <br /> 01 - 0 - 2 - 4G- 1�-io S- iS- )2g - ZU-500, ,QX k - t <br /> SINGLE FAMILY DWELLING IV GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ SSR"SR o r <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING�❑+ CAEl UNIT BUNKHOUSE 59.692(1V)GAZEBO DECK <br /> t- ❑ <br /> STRUCTURE/ADDITION USE: � 6 J 1 'Y p <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> oBUILDING CONTRACTOR: C <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> o � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. .�f O <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) n <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. o rn G Z <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. }P- Q <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 /> -3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 7� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Ci 0 <br /> c�1 <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. n 3 <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 (f 0 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY, <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> 179x0 `9 7. <br /> ye Fa H <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge <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 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 C' <br /> permit county officials charged with acirpinistrating county ordinances or other authorized person to have access to the above- o N n <br /> described premises at any teTab] fortqepurpose of Inspection, W R4� <br /> OWNER'S SIGNATURE /3O 2a 2dZONING ADMINISTRATOouo= <br /> w <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U o w N <br />