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Burnett County 7410 County Road K, No, 102, Siren, WI 54872 Office of Zoning Administrator 4 y z <br /> APPLICATION FOR LAND USE PERMITS - = W <br /> OWNER \ 1 ' c <br /> RR�•t } �1� �N IBJ TELEPHONE <br /> MAILING ADDRESS l3 ''lb <br /> L r s, $6 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION �oT S � �Ot,.- ` �(o -17 L - 3a - (S <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE <br /> 4 <br /> BUNKHOUSE 0 59.692(1V)GAZESO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 I� J <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: G z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c <br /> BUILDING CONTRACTOR: F�\� S - 5 - 60 <br /> L <br /> n <br /> C 3 i� � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C c v" <br /> WILL BE RETURNED. <br /> z. <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. C y <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW r rP �'- <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ` 10 -_ <br /> AND INDICATE NORTH (N). J � 7 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) Q j <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - <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 'o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 4- .s <br /> o d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN i <br /> NEEDED. _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .-. <br /> I ~ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B <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. — r1 In <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. f <br /> 7. � > 0 oc$ :J <br /> h R <br /> n3 '°T77 <br /> I declare that this application <br /> on(Including any accompanying schedule)has been examined by me and to the best of my 3 a� 2 P a ,,, s <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all s <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that thisE. > > a <br /> Information I am pmviding will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I 'd `• c = ; Y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this z 'eG in L'�.`-�+ 10 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have 0,3 6 8 r, <br /> access to the above-described premises at any maw ab a time for the purpose of Inspection. 6 8 c, <br /> c ° aBY'g8 > <br /> OWNER'S SIGNATURE $ 2.L b <br /> date o FgZONING ADMINISTRATOR '� � c aa' ; =p ;slama , <br /> OWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a^N w <br />