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b z <br /> Burnett County 7410 County Road K, No, 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y H <br /> OWNER /-, /Q� C,� !C/C.�Sv F�2 TELEPHONE <br /> MAILING ADDRES� i!/�i /�if�^y K r��/ <br /> PROPERTY ADDRESS T�, `1 T00 LA IV rA� Zlr— dA. <br /> y� o a O <br /> c GQ R <br /> CMN <br /> SINGLE FAMILY DWELLING❑ GARAGE/ACCESSORY STRUCTURE O ADDMOf# STAIRS ❑ , n1 <br /> TYPE OF PERMIT(S): V" <br /> FILLING/GRADING❑/CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GA-{Z�EBO� DECK❑ n <br /> STRUCTURE/ADDITION USE: J"� E <br /> (Home/Cabin; Comme al Business; Bedroom; Deck; etc.) c <br /> BUILDING CONTRACTOR: <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS < <br /> WILL BE RETURNED. p °— <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ole. C C- <br /> 1. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y n n <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, M ' 9 <br /> AND INDICATE NORTH (N). N u o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES C ` <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 1. IN::iCATE I'A WALKOUT BASEMENT IS -PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ,^,' `m <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN i <br /> NEEDED. <br /> -3 4� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: h <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. it CJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n (A) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. et z .� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER P <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 /> 7. £ <br /> I declare that this application(including any accompan I schedule has been examined by me and to the best of m knowledge > c g 7 <br /> ( M Ye ) Y g �. ^.d ^ n. tlf <br /> and belief It is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all Information �. a G'»:c <br /> contained In this appikation(including any accompanying schedule)and I further dedare that I recognize that this information I3 0�w' !; w <br /> am providing will be railed upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further accept all m C. <br /> liability that may be a result of the myof Bumett relying on this information I am providing in this application. I agree to �� y <br /> permit county officials charged wI ministratlng county ordinances or other authorized person to have access to the above- <br /> described premises at any rea for the purpose action. o d N 8 N U 8 <br /> r <br /> ����� <br /> OWNER'S SIGNATU G��"' � <br /> �lahZONING ADMI TOR Jdm an�jo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE V n <br />