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I <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ri a <br /> APPLICATION FOR LAND USE PERMITS (N <br /> OWNER � NAC I V (' / R ( � TELEPHONE 7(/p3— <br /> (A h <br /> MAILING ADDRESS C e/' / Q 5S2 C/ <br /> C..) <br /> PROPERTY ADDRESS ci <br /> d <br /> LEGAL DESCRIPTION CQ � /Q in IC �+ <br /> SINGLE FAMILY DWELLING O G RAGE/ACCESSORY STRUCTURE -ADDITION O STAIRS O o �F <br /> TYPE OF PERMIT(S): ^ <br /> FILLING/GRADING O CAMPING UNIT O BUNKHOUSE O 59.692(1V)GAZEBO O DECK O <br /> STRUCTURE/ADDITION USE: Z g <br /> (Home/Cabin; o mercial Business; Bedroom; Deck; etc.) o P < <br /> I <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SH EET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE LOT PLANS r) <br /> WILLWILL BE RETURNED. F <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR I OP VIEW) C <br /> r � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I t7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXI TING BUILDINGS/STRUCTURES (EB)AND ALL NE W ^—r K <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 'O <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) E JILCING(S) .F <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER 4ARK a3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. n <br /> 4. SHOW THE LOCATION OF THE WELL(W), SE TIC TANK (ST)AND DRAINFIELD (DF),AND ALL ISTANCES II, c <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 /> �IpY;1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE C)\ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BED NE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: UI <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 z ,may <br /> 3. NO GRADING OR SHORELAND ALTERATIONS RE ALLOWED UNLESS SPECIFICALLY PERMMEI 8 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WA TER d <br /> SETBACK AREA. C <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STOP GE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. _ p <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my nowledge <br /> and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all inforn ation 2 = <br /> > <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this inip mabon I i- <br /> am providing will be relied upon by the County of Burnett Wisc nsln In determining whether to Issue a permit. 1 furth accept all <br /> liability that may be a result of the County of Burnett relying oil this Information I am providing In this application. I at ree to <br /> permit county officials charged with administrating county ordi lances or other authorized person m have access to the above- e A <br /> described premises at any rea able time for the pY o!I spection. ¢ 0 <br /> a <br /> OWNER'S SIGNATURE <br /> (date) i yt : '�o > •t1 <br /> Q dvI<`w' M <br /> ZONING ADMINISTRATOR <br /> C — <br /> 4 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ O M € N <br /> Perm r4 4 fe�f4e.,- pt (yea/ kp bV n,�c�rJ., 0 1St�� <br />