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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Admini!trator ti V z <br /> APPLICATION FOR LAND USE PERMITS c <br /> OWNER LT,4/vv11 Cf_j I TI7L C TELEPHONE 37�6_ ycl 7 _ 0 <br /> MAILING ADDRESS /L, G G // <br /> PROPERTY ADDRESS <br /> O <br /> LEGAL DESCRIPTION n <br /> <. <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE IN ADDITION ❑ ST IRS O o 6 <br /> TYPE OF PERMiT(S): � � o (I) <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DE K ❑ <br /> STRUCTURE/ADDITION USE: G rl p G E � � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLO1 PLANS <br /> WILL BE RETURNED, p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> � 6 <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 <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) BUILDINGS)TO ALL LOT LINES, (B) BUIL ING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAR 3 <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 DIS NCES y o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> I(hJ <br /> 5. INDICATE IF A WALKOUT BASEMENT I5 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. � <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. _ O <br /> -I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN <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. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n p, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 9 I Q 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER V <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E O <br /> 6. <br /> ^ fig >nx}7> S <br /> 7. <br /> " � � <br /> I declare that this application(Including any accompanying schedule) . 1 3 <br /> schedule)has been examined by me and to the best of my kno ledge 5 Z y�K „j <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Informatio o <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this Informal n I `^ <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further a pt all M`" -; <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree ii S `, ^ r <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the abo <br /> described premises at any reasonable time for the purpose of Inspection. <br /> 1 I $2 u O <br /> OWNER'S SIGNATURE �wrr-er - /b 2 O <br /> c' T (date) 6 > <br /> ZONING ADMINISTRATOR I F(GLVII <br /> It �JJ. <br /> U( <br /> e - <br /> TOWNSHIP PERMITS MAY BE REQUIRED ? C _2 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE dN S W U o <br /> 04M14- 4- le4p- pickeliU� ✓u/hes ¢�� �P� sfe z� -3o-d � <br />