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C A O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER J ELEPHONE p "� <br /> errs, 01673 cell n o <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS t e o I <br /> u u 4 n P- Si r-e n� �Z�L S I;2 a <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 1P ADDITION STAIRS 0 W �. <br /> TYPE OF PERMIT(S): �- <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(iV)GAZEBO ❑ DECK O <br /> H .o Sr <br /> STRUCTURE/ADDITION USE: o/i'7 th WI ��(Y/Qlrl alod(rN C <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) / L o .� <br /> BUILDING CONTRACTOR: rri 8LL ees r tl Y 3 •+ pN\` / I� <br /> c vl <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. o_ y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ^_ n <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) BUILDING(S) N Z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. a' <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL. DISTANCES p C) <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rn Q <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. J� <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 �. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �y <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. IN <br /> 6. <br /> 7. f <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge mR g 9 R <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all InformationR " „.2 <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I L Z o -o' E: <br /> am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all w e C k <br /> liability that may be a result of the County of Burnett relying on thls 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- w 2 y y <br /> described premises at any rea onabl , <br /> me for for the purpose of Inspection. <br /> AA/ n <br /> OWNER'S SIGNATURE �'i" l.'C / -[�S r��v ro w ti z '-' y <br /> (date) <br /> ZONING ADMINISTRATOR / o w' $ a Z <br /> TOWNSHIP PERMITS MAY BE REQUIRED aw <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE s <br /> 'PC�(ni� d- I e-�e►'���cecf U� b�� J�✓r� Kolb 3- � u-c� ��� o�N o <br />