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�(- <br /> E t / � <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Ing Administrato < P <br /> APPLICATION FOR LAND USE PERMITS - i <br /> y y <br /> r� (� <br /> OWNER J '& r lrh TELEPHONES AV <br /> U fyCy � E <br /> MAILING ADDRESS �1 `\ �_ <br /> T n ` , C � <br /> PROPERTY ADDRESS 7 L� <br /> LEGAL DESCRIPTION / SM _ L / _I C o <br /> SINGLE FAMILY DWELLING 0 GA G CESSORY STRUCTURED ADDITION 0 STAIR .. <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADI G 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 .e <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: E n�. � I Z vz-I 949' / <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAN <br /> WILL BE RETURNED. C o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C f+ <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). .o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS N J Z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK P <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. S. C) <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCE ty <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 15 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. '��' rn <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 i <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. B z `L <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. /W„ <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. IM_ <br /> 6. <br /> 7. F <br /> ^ poem aoro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <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 <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. I agree to i:34 <br /> _ y <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- $ ^ D <br /> described premises at any reasonable time for the purpose of Inspection. <br /> i/JJ/ (��[//`L��r� J��f j�- <br /> OWNER'S SIGNATU / 'CF L�Ci 2 <br /> (date) 5 <br /> ZONING ADMINISTRATOR �/t m "V 4(C1C�t� n V' g o. <br /> as > z <br /> Yi <br /> TOWNSHIP PERMITS MAY BE REQUIRED y a' to <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE P <br /> kof 4-o Igo�l�Pke H' <br /> N t2 W u w <br /> � o <br />