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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 cN <br /> OWNER M _ 1L ; �u ( N TELEPHONE <br /> MAILING ADDRESS SZI `IO V l Q <br /> W = <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> Sec. S T 3rd ISW <br /> SINGLE FAMILY DWELLING[ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S): 4- <br /> FILLING/GRADING %- CAMPING UNIT 11 BUNKHOUSE 1159.692(1V)GAZEBO ❑ DECK p(, <br /> 0 <br /> STRUCTURE/ADDITION USE: 0 (AM Z �� <br /> (Home/Cabin; <br /> Commeercrcial usness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �P &x <br /> (%- -c,tolc, I Wa- ado <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1F2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS .n s <br /> WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) `= <br /> n <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW ^- m <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) ` o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 93 <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 �. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> S. 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 _� I <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 p '1 <br /> NEEDED. VV 6 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. F �- O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n 0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N \ r <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER UI <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. , I�- ^ � >oao > o 0 <br /> (�f— m <br /> 7. R ` 2 R F [s7 <br /> ym ya FFf: = 'A <br /> 1 declare that this application(including any accompanying schedule)has been examined byme and to the best of my knowledge 3 <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 d ^ <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all cN N No .fid <br /> liability that may be a result of the County of Burnett ying on this information I am providing in this application. I agree to R 021 <br /> permit county officials charged with admin strat g c ordinances or other authorized person to have access to the above- <br /> described premises at any reasonabl im for of Inspection. y <br /> 16-16 -o-7 <br /> OWNER'S SIGNATURE Z <br /> --'� (date) >> <br /> ZONING ADMINISTRATOR M F `/ n s7 <br /> r, <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v w w <br /> o � o <br /> aflirn- leUleb✓oe <br />