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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS a UJ <br /> 6 <br /> OWNER TELEPHONE <br /> Tltio ws + �rti �ux-cs <br /> C,� <br /> MAILING ADDRESS /10/( J V/,��D fir <br /> n <br /> ^ (� w <br /> PROPERTY ADDRESS <br /> n <br /> LEGAL DESCRIPTION <br /> {.0•(-.2 6nu L=k'1 5lea. 3(� T Nff)N R IY f-y <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION Xf STAIRS 0 2 <br /> TYPE OF PERMIT(S): I� <br /> FILLING/GRCAMPING MPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 d <br /> 11II <br /> STRUCTURE/ADDITION USE: r-ve Mr /LIaL.• <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN B V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS w ,A <br /> WILL BE RETURNED. See- (�a a/'{ A c <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) I a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'tJ <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, rnO J <br /> AND INDIATE NORTH (N). r) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) .lam 5j <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK J ta/� .o <br /> 4. SOHOW THE FLAKE, STREAM LOCATION OF THOR RIVER AND E WELL(W)5 SEPTIC TANK(ST)AND DRAINFFIELD (D)I AND ALL DISTANCES R <br /> TO BUILDINGS, ROADS, LAKE, LOT LIMES. 0° o <br /> 5. INDIATE IF A WALKOUT BASEMENT I$ 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. yt <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN o <br /> NEEDED. CA <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r z C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER IT.nn Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI E.E.. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIPE <br /> FICALLY ITTED. ^�W"` R <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 000 a <br /> SETBACK AREA. O' <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. n <br /> 6. M 4-X 1560 • (ilc .�M AI / v � no m <br /> 7. � 4 - 5p?— <br /> TO- ,,41WA4., - S-al is Ua 9 '""F. <br /> _ <br /> I declare that this application(Including any accompanying schedule)has been examined by me nd to the best of my knowledge g z ,,, 1 .3 <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information 19 o g <br /> contained in this application(Including any accompanying schedule)and 1 further declare that I recognize that this Information I Ei <br /> : �„ .n 4 <br /> am providing will be railed upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all c N 8 v o r <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 06 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for urpose of inspection. " c)y <br /> -- z <br /> OWNER'S SIGNATURE 71110E Rm = y d <br /> (date) <br /> ZONING ADMINISTRATOR <br /> c C7 <br /> OWNSHIP PERMITS MAY BE REQUIRED <br /> fis �w N y <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />