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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n <br /> APPLICATION FOR LAND USE PERMITS 7Uj <br /> Fi <br /> OWNER I1.�R. � Ctp. TELEPHONE yI I.S6A <br /> fd L / <br /> MAILING ADDRESS <br /> 11-109 div i&,4 Vie. Am zo z <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION arSTAIRS ❑ <br /> TYPE OF PERMIT(S): .. ro <br /> FILLING/GRADING ❑1-1/CAMPING UNIT 11 BU-NKHOUSE 0 59.692(1V)GAZEBO ❑ DECK❑ � <br /> STRUCTURE/ADDITION USE: G-- c 0 <br /> �7 (Home/Cabin; ommercial Business; Bedroom; Deck; etr.) <br /> BUILDING CONTRACTOR:Q '? OJ l°��S�I N(o.�OD '�u G#.y� _5 �tv/r✓ <br /> age-ab38` curl <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. M S <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 C c� <br /> y <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, to m <br /> AND INDICATE NORTH (N). n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ,o <br /> 4. SHOW THE FL CATIONROF THEAM OE WELL(W),SR RIVER AND EPTIC TANK(ST)ANDD ARE ,ANDDRAINOF ELLD(DF),AND ALL DISTANCES N P <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' o <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, <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> H <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. I lllnn <br /> l <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. ' <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. 6, I\ <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <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 /> P �° 25 <br /> 7. �• �'S :�' 0 6 <br /> 7 aae vw <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 o ff? y <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> CyKb "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 6 G� <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- to <br /> w (� <br /> described premises at any reasonable time For the pu5pose of Inspection. <br /> OWNER'S SIGNANRFJ "W.� R 7 0 <br /> /; (date) H o S <br /> a <br /> ZONING ADMINISTRATOR �./ Fl <br /> E <br /> TOWNSHIP PERMITS MAY BE REQUIRED " c` <br /> v�u j yN In <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE = N ^ <br /> f4m-zi , v te+ Pw /Walled �0 -&rm C)n_skUZ 7ah q--/q-0'2 <br />