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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS g p <br /> OWNER �C61a r� I I�ILr(rs� �I C�D� TELEPHONE <br /> MAILING ADDRESS �S whI�TIL7 �d 0� 1' wn(�, 64k 1+4--s m/J /ab <br /> ii r p <br /> I" i SE <br /> PROPERTY ADDRESS `� 3i }�' U vi I_1G(m LaLe e edJ <br /> LEGAL DESCRIPTION 5 <br /> 5 <br /> DWELLING/BUILDINGARAGE/ACCESSORY STRUCTURE ❑ ADDITION O STAIRS ❑ o 1 <br /> TYPE OF PERMTT(S): <br /> FILLING/GRADING❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ DECK❑ ^ �. <br /> STRUCTURE/ADDITION USE: NOIR Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deckle; etc.) o P p <br /> BUILDING CONTRACTOR: _ 6 recvl ) Rao, Cit <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER, ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS m y <br /> WILL BE RETURNED. O <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 Cy <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, M 'O <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) C e <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK e <br /> (OHWM)OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES �. n, ? <br /> TO BUILDINGS,ROADS, LAKE, LOT LINES. w' yJ <br /> 5. INDICATE IF A WALKOUT 9') <br /> BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. G o C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHTTECr, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE <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 90 <br /> NEEDED. Q, <br /> THIS PERMIT IS SUB3ECT TO ALL CONDITIONS LISTED BELOW: (a 9 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C;T O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n j <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. B <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER J O <br /> SETBACK AREA. a <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> w � <br /> 7. IV a.F 77 <br /> DP (including Yaccompanying ) Y Y g 3 ;` gp ' w <br /> 1 declare that this application Indudin an schedule has been examined b me and to Me best of m knowledge p z y�n <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I «i <br /> am providing will be refiled 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 Burnet relying on this Information I am providing in this application. I agree to m 8 " s <br /> '^ 8 <br /> permit county officials charged with administrating county ordinances or other authorind person to have access to the above- 8 <br /> described premises at ny reasonable time for the purpose of Inspection. m w w_? y <br /> SIGN HERE <br /> (signature of owner building contractor) (date) `^ s <br /> ZONING ADMINISTRATOR Sirn Dan( /'-, <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> H: M: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N 8 U o <br /> Le (- PiGcevp lot) 0 <br /> I b 1 r7LOL) <br />