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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c ro o <br /> APPLICATION FOR LAND USE PERMITS a . <br /> OWNER l#1&e okolc TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> < O <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S): g' <br /> FILLING/GRADING ❑/CAMPING <br /> /UNIITT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ Q <br /> STRUCTURE/ADDITION USE: UO(� (/ryw — (7zrr--c✓y� –_ <br /> (Homee/Cabin;/Commercial Business; Bedroom; Deck; etc.) ck P <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> n <br /> WILL BE RETURNED. <br /> A < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C 2. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEWn <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURESm <br /> AND INDICATE NORTH (N). , <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (6) BUILDINGS) d r <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, <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES 0 o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. R. n \ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O w o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE a 0 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONS <br /> NEEDED. ITE VERIFICATION MY BE DONE WHEN <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. H <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 ONLY. V <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7Yompa <br /> . c7 b <br /> A m o E <br /> o' _ � <br /> I declare that this application(Inducting any accompanying schedule)has been examined by me and the best of knowledge <br /> and belief it Is true,torted:and complete. t acknowledge that I am responsible for the detail and accuracy <br /> El <br /> complete. racy of all Information <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this information I e .. Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all d ..u"''^ <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 m On 8 8 r <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for the purpose of inspection. m m <br /> 5 <br /> OWNER'S SIGNATURE_ P.(iLt G �b Z3 p K7 S n O <br /> a . <br /> Sn FlQ n (date) sn N rn <br /> ZONING ADMINISTRATOR 7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE p N 8 o <br /> 'crm� + lei der ricked rip by Terry Dkohe <br /> ) b-a3-o? <br />