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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 <br /> OWNER LILIV- C IVAI nCKrlsh -' 4—Jj Y1T LEPHONE <br /> MAILING ADDRESS 'a1-1 -� S Pd Q C-T 0-1/ . bu <br /> Pd v� q <br /> PROPERTY ADDRESS I^ �I o� j.., , (Q/J O 6� .S ro L'r P <br /> LEGAL DESCRIPTION C L S I/a 5 kj C.0 + � )(O ' C 5 W C.O e) < w <br /> H (V LI ( o"1 T�{ E LA(01 ' <br /> T H S Lt(e'71 <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE Bl ADDITION ❑,,a$TAIRS ❑ o <br /> TYPE OF PERMIT(S): -b PO 13 ,o <br /> FILLING/GRADING [ICAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 <br /> STRUCTURE/ADDITION USE: 'Y. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) r P <br /> BUILDING CONTRACTOR: SG <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. < <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. .ni 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, m b <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) on <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE a C7 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Yt <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. I <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. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER LT <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7yanma � 'o <br /> 7. F R R'2 IT 6 EFO <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge El m <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information '° e <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I w 'h ;n <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 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o <br /> described premises at any reasonable time for the purpose of inspection. m w H c y <br /> OWNER'S SIGNATURE e�lX- .l,(� �( J, Q� o A g c� 2 <br /> ��� (date) +A $ 6 <br /> ZONING ADMINISTRATOR V' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 o <br /> tkr(n-l� le 4-kV rV-�d &ja b�/ !U(s� rnerih <br />