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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c s z <br /> APPLICATION FOR LAND USE PERMITS a <br /> Qp? $ so <br /> OWNER � TELEPHONE <br /> (Y I <br /> MAILING ADDRESS (/til)T)2� D ., �d&�� / �N 15/a� (� r <br /> �j / R <br /> PROPERTY ADDRESS <br /> /C <br /> LEGAL DESCRIPTION '-) <br /> o `) <br /> E z dfT?gE 5wI/4 _A /4 5crr z'( I 39 n) A/ to ��'"'7 F � <br /> TYPE OF PERMIT(S): <br /> SINGLE FAMILY DWELLING)ir GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 13STAIRS 0 b <br /> � <br /> FILLING/GRADING ❑ CA IN UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK❑ � <br /> STRUCTURE/ADDITION USE: �O/rls= / Ct�6/A) W/ /O x7 i¢.JO /ax IN Coiktztptoo kctt�5 z i� <br /> (H <br /> ��o <br /> Ccme/Ca�b <br /> +'in <br /> �; t�rommercial siness; Bedroom; Deck; etc.) .°r. <br /> BUILDING CONTRACTOR: J-1,4(-J-1,4(- �/— eSI�/✓l <br /> J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vt X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS m 0 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 <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] <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, t+ <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) e <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK B <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES J o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. $? c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE . "� cxz <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. rr k,1 <br /> H W <br /> NOTE: BIIiLDINGJSTRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN I <br /> NEEDED. <br /> THIS PERMIT IS SUB)ECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENT'S WITHIN 60 DAYS OF PERMIT. r z <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. (7 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. ¢ <br /> 6. <br /> �$7g� gE. <br /> 7. .OF <br /> I dedare that this appik etion(Including any accompanying schedule)has been esamined by me and to the but of my knowledge B " C <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the dotal and accuracy of all Information ' p <br /> contained In this application(including any accompanying schedule)and I further declare that I recognice that this Information I m <br /> am providing will be reled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept al fr d\u c u <br /> IlebNky,that may M a result of the County of Burnett no on this Information I am providing In this application. I agree to n/ *O <br /> Permit county officials charged with administrating county ordinances or other authorperson to have access to the above- <br /> described premises at any reasonable time for the purpose of Inspection. n p _ y <br /> OWNERS SIGNATU Z/6/0 7 x <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERM SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o� 8�u 8 <br /> F�2rrr i ��e 1 1�✓ mai 1 e of -�aLL�Dn I fel l2 a-1 l <br />