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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administral�or n z <br /> APPLICATION FOR LAND USE PERMITS . <br /> X <br /> OWNER TELEPHONE I��' 616 -7777 o <br /> qlirQIt• 321 a e <br /> MAILING ADORES �fS'S7' I914e d. 'Z7 <br /> 35 8 -1 , b ,, GJT ,SS -V3v) - 0 3.x' Ir I o <br /> PROPERTY ADDRESS S, <br /> 14-1 awe�f 16 vi Scvr`rs 'Tw,+sL ' <br /> LEGALDESCRIPTIO LOT / CSM v4 /ate n J T <br /> (iN +SUV 4uTY SPCfior 2 //jti <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Pt ADDITION ❑ STAIRS o (d <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GA2EB0 ❑ DECKII <br /> STRUCTURE/ADDITION USE: :t A I-t .L Av r 4 Z <br /> (Home Cabin; Commercial Business; Bedroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT P NS y <br /> WILL BE RETURNED. O 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) = c P <br /> —1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 T <br /> .- 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, w <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 a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. I v, Z <br /> v4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTAN ES 2. I� 9 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. o$ O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. G w <br /> - 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,T E <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. .". <br /> .3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHE N Y'd <br /> NEEDED. ! L <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: S <br /> r � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. F Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Cy <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER CJI C: <br /> SETBACK AREA. <br /> —.i5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ON Y. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> ^ 7y �nm qa a <br /> s <br /> w <br /> I d bell that this ,con tion(inducting any accompanying schedule)has been examined d by me and u the best of or ation dg � 2 w�r —y <br /> and belief K B true,cornett and complete. I acknowledge that t am responsible for the detail and accuracy of all Information o 2 <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this Information I 2 ` > <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept i 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. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o <br /> described premises at any reasons a time for the urpose of Inspettbn, w n v,m r y <br /> y 7ppb 0'= ••] <br /> OWNER'S SIGNAoj <br /> TURE! �� / Ly F -•�_ i Q n g �C: <br /> CT (d ) {^9 �sg� �1 <br /> ZONING ADMINISTRATOR v 'm <br /> G ` <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Pe I'm pC— L., p 6 L j L'k,arLcs <br />