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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator e n o <br /> APPLICATION FOR LAND USE PERMITS a <br /> , V�✓� <br /> OWNER � ��A TELEPHONE /,,/ <br /> MAILING ADDRESS (U1 � h,. [!►1� / YT� V� 0 <br /> PROPERTY ADDRESS 2���� (. r, ��e� SV b�I�iS/J/l k' \ <br /> LEGAL DESCRIPTION J LRK �Oh 5fc.5 Q(Sw s <br /> l I/r lX0. 2 1VI 'T3�� r <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ '3TIRfReJ' <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING 11CAMPI UN ❑ BUNKHOUSE 13h59.692(1V)GAZEBO'� DECK 13STRUCTURE/ADDITION USE: �rp�1� .o c 0 <br /> ///--++ (Home/Cabin; Comme/rcial BusiJn ss; B om; Deck; etc.) <br /> BUILDING CONTRACTOR: r lere '1LGtCh' C�yS�/�f � / <br /> G DWGlI / yD1C'Jih Pond d�a..Mr-na 5 `� l.(LA'fI/fV �, <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y=X11 SHEET OF PAPE . ANY INCOMPLETE R ILLEGIBLE PLOT PLANS C <br /> WILL BE RETURNED. a ., <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <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 y <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, th w <br /> AND INDICATE NORTH (N). n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(5) 9 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK(OHWo <br /> 4. SHOW T THELAKE,STREAM LOCATIONOF THOR RIVER AND WETLAND E WELL(W)5 SEPTIC TANK(ST)AND DRAINF EDD (D)I AND ALL DISTANCES ti <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 00 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, 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 <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r Y <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 8 1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <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. ansa 790 '0 <br /> enX � o $ g ItA <br /> 7. <br /> N A Gv_ ^I= .3i <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge R, �, w 2.: <br /> y <br /> and belief It Is We,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o : y <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> N N N N <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 tpe Coun o B relying on this Information 1 am providing In this application. 1 agree to <br /> permit county officials charged/rlth ad n a my ordinances or other authorized Person to have access to the above- N Z' (1 <br /> described premises at any rea_s kiln bie r se of Inspection. E n "'c = y <br /> e R <br /> OWNER'S SIGNATURE / (date) " N <br /> ZONING ADMINISTRAT01{ � ? <br /> TOWN IP PERMITS M BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> U 8 Uo <br />