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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Adminl�strator _ c <br /> APPLICATION FO1 LAND USE PERMITS <br /> II <br /> 6 C <br /> OWNER _ " t �(^1�5 rL TELEPHONE <br /> 17 c� C1 (O✓ / n <br /> MAILING ADDRESS OV'�I Ram, ivy <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> 3 9 <br /> TARS ❑E/ACCa Y STRURvo 61—ON FAMILY DWELLINGZk GA dES ❑ D _ <br /> V` c <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ 3 $. <br /> STRUCTURE/ADDITION USE: n e P S <br /> H me bin C m rciat Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: `—" ✓� / �_ ( „1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHE # •OF)PAPER. ANY INCOMPLETE OR ILLEGIBLE PLITT PLANS <br /> WELL BE RETURNED. - "----— F < <br /> —`._...-. — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TO VIEW) I o r <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES T BE SHOWN OR DRAWN TO SCALE. inS <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTI NG BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NO), INCLUDING DE KS, PORCHES AND OTHER STRUCTURES, m <br /> AND INDICATE NORTH (N). n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWI G: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEAS REMENT(S)TO THE ORDINARY HIGH WATER MARK I 3 <br /> (OHWLAKE,STREAM OR RIVER AND WE1-AND AREAS, AND(D)LOT DIMENSONS. <br /> 4. SHOW T EFLOCATION OF THE WELL(W), SEPITC TANK (ST)AND DRAINFFIELD (D)I AND ALL DISTANCES ? ly J o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. °' .., Q' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNI D AND SHOW AREAS TO BE GRADED OR FILLED _ _ QJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY ANA HITECT, ENGINEER, BUILDER, CONTRACTOR, E C.,THE _ C <br /> PLANS MUST BE SIGNED AND DATED BY THE 0 NNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE S AKED SO AN ONSITE VERIFICATION MY BE DON E WHEN <br /> NEEDED. _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTEDBELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. F v 1 <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. L' \ <br /> 4. NO STRUCTURES,INCLUDING RETAINING WAL , ETC.,ALLOWED WITHIN THE REQUIRED WATER a <br /> SETBACK AREA. C> <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGEISTO GE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. <br /> I declare that this application(Including any accompanying scheJule)has been examined by me and to the best of my k owledge Z ^ -J <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 1 J <br /> am providing will be relied upon by the County of Burnett Wisco sin In determining whether to Issue a permit. I further accept all S = <br /> liability that may be a result of the County of Burnett relying on this Info ation I am providing In this application. I agree to "' <br /> permit county officials charged with administrating munty ordin nc o r authorized person N have access to theabove- o f+ <br /> E <br /> remises at any reasonable time for the purpose of In ion. <br /> described `^ ci <br /> P P <br /> .w' <br /> L c ^ g �LZ <br /> OWNER'S SIGNATURE w <br /> (date) 71 <br /> > <br /> w +f <br /> qj <br /> ZONING ADMINISTRATOR �. <br /> gi <br /> TOWNSHIP PERMITS MAY BE REQUIRED G' <br /> « <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> -� Imo+ a-�r 01cted Up b y Dan FIOG�I L4 30- 07 <br />