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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS o y <br /> A TELEPHON��s�) <br /> OWNER I eC� .�, /�,�� II� S� _ / C <br /> Ir/J 111 /,J( GGII 4 �i <br /> MAILING ADDRESS / vv <br /> 'Z (T(,-Ir /YA �` <br /> 5 so7G = .� <br /> PROPERTY ADDRESS ^� q cJ / 0 1 <br /> LEGAL DESCRIPTION <br /> 0 <br /> TYPE OF PERMCf(S): <br /> SINGLE FAMILY DWELLING 13GARAGE/ACCESSORY STRUCTURE.0e ADDITION ❑ STAIRS ❑ I �. <br /> e^, <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ !� <br /> STRUCTURE/ADDITION USE: QG_Or <br /> (Home/Cabin; Commercial Busin s; Bedroom; Deck; etc.) �'Z <br /> BUILDING CONTRACTOR: Qtyw <br /> �d0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 <br /> WILL BE RETURNED. Vc <br /> O — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VIEW) n c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ht <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). lTl 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) e <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. 5' J <br /> 4. SNOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES C OI O <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 1 <br /> S. 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 C <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. c <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. R Z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA, F O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <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 6 <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <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 Burned: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- $ 9 <br /> described promises at any reasonab a time for the purpo of Inspection. <br /> n �' NBNuoC^ <br /> OWNER'S SIGNATURE <br /> (date) <br /> ZONING ADMINISTRATOR <br /> m Fl �� an o � �2 0Z�y <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> T`HHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a <br /> t e✓ d �e ✓�/ p b <br /> ✓1'1 � �e�iti < U s�No <br /> 3-/(-E- D9 <br />