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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS a . <br /> 6 V' <br /> OWNER - <br /> /- / rrj h�� er TELEPHONE <br /> T c� / <br /> MAILING ADDRESS QJ <br /> 70 5TH ' $ <br /> PROPERTY ADDRESS /0 O <br /> S 9 �, 5 0 <br /> LEGAL DESoPTI <br /> CRIONZo f <br /> V b <br /> r, t5- 10-le ;(Q rJmo=t /3 -rqo R- <br /> TYPE OF PERMTI( g o <br /> CCS): SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRs ❑ a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DEC <br /> STRUCTURE/ADDITION USE: R12 14(' �k'S7//�1 P <br /> Z <br /> (Home/Cabin; Commercial Bu7ness; Bedroom; Deck; etc.) o P <br /> BUILDING CONTRACTOR: �Q O Sa�? !S ��✓ S "T�C <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT Pl.kNS n <br /> WILL BE RETURNED. O r <br /> z � <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDIN (S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. N v, <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTAN ES �. c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <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.,TI IE _ S�j <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. /v_) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WH N <br /> NEEDED. i U f,) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. p Q <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. 8 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE 0 Y. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> xao gg7. � <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowled e <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information e p: ' <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information ;,,Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further accept II c n <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 .ri <br /> permit county officials charged with edministrating county ordinance or other authorized person to have access to the o t7 <br /> above- <br /> described premises at any reasonable dor the p rpm of Ins on. /1 - Q .te_ 3 _ i <br /> OWNER'S SIGNATURE z. <br /> (date) `, g <br /> ZONING ADMINISTRATOR <br /> v l <br /> II rn <: p <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N 8 N N o <br /> P�✓�-�`�-f �- I�t-I� r���le d -la C�-,-so„ akl IdQ� s a - � �o� <br />