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� � o <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> 715 <br /> OWNER TELEPHONE a1 <br /> 7� S SS7 v�63 <br /> o <br /> MAILING ADDRESS 6�( ///,n� C.—✓'L.SIG �d-..0(,ter Y 4(I ) YI'�l-`'D� l' (U <br /> 0.� <br /> PROPERTY ADDRESS b 1 <br /> �7 I et^ . o � �ri vG a� ,.� r l•'VL .o �. o <br /> r <br /> LEGAL DESCRIPTION • .. <br /> lie �/ I � 6 3 <br /> SINGLE FAMILY DWELLING GA GE/ACCESSORY STRUCTURE ❑ ADDITION 0 STAIRS ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPI G UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK❑ <br /> STRUCTURE/ADDITION USE: 6z- <br /> (Home/Cabin; <br /> i'""� r~(Home/Cabin; Comm tial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: f C Q)W <br /> r1 � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C <br /> WILL BE RETURNED. O 2. <br /> e <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M ^0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) N o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK $ ( j <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. B <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 /> 5. 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 <br /> o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN G <br /> NEEDED. y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' J <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. R Z UJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER P J O <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. !�� <br /> NOT TO BE USED FOR HUMAN HABITATION. V <br /> 6. <br /> E <br /> 7. ' <br /> n D90 ^d <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge mn <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> zs a'= <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information I 3 e w c ' ? w <br /> am providing will be relled 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 Burnett relying on this Information I am providing In this application. 1 agree to n a <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> w i., »_�nwiHi <br /> described premises at any reasp ablg time r M a of pection. o (w N g N N g <br /> OWNER'S SIGNATURE <br /> _6 <br /> —� (da ) <br /> ZONING ADMINISTRATOR <br /> w n by <br /> � e —aw tr1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O '_ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE c, <br /> ��m, k le 1 e✓�(cic� j,y° 64 KeitG) Pe- G <br /> U O lA lA O <br />