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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administra or c <br /> APPLICATION FOR LAND USE PERMITS <br /> 6 <br /> 53 <br /> OWNER D ��/ at TELEPHONE `7 <br /> MAILING ADDRESS p r1 /�0 f/l�/ p / o� �C�7�"6 4--;/— <br /> PROPERTY <br /> ✓fPROPERTY ADDRESS ��! 2 2 5 i�//1 v fv—f <br /> LEGAL DESCRIPTION �' S <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIPSO G <br /> TYPE OF PERMTr(5): <br /> FILLING/GRADING ❑ CAMPING <br /> -1UNIT ❑ BUNKHOUSE <br /> /❑ /U6.' ' <br /> 59C..692(1V)GAZEBO ❑ DECK ❑ I� <br /> STRUCTURE/ADDITION USE: G / I o a Y�(.t Yl I'I6 �- <br /> (Hom / abin; Commercial Business; Bedroom; Deck; etc.) a <br /> BUILDING CONTRACTOR: I^ <br /> n <br /> r� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER, ANY INCOMPLETE OR ILLEGIBLE PLOT P NS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C I A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). r7 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDI G(S) ,03 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o N z <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTA qCES �. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. 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.,THE v, a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. .-9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z c p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. F S J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ( r, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE DINLY, <br /> NOT TO BE USED FOR HUMAN HABITATION. C7 <br /> 6. aE P%1 <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my know edge Z m n �j <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informatlo ,� !, <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Informal n I ,� ; - - «� .p <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further acc pt 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 I o <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> to <br /> S o = <br /> described premises at any reasonable time for the purpose of Inspection. <br /> V —_ n z <br /> OWNER'S SIGNATURE (daf° 'O o^ > ? sy <br /> —(date) � rpn': �_$w � <br /> (rn FLlin <br /> ZONING ADMINISTRATOR `- <br /> � UE <br /> TOWNSHIP PERMITS MAY BE REQUIRED " 0' <br /> dN Su, No <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />