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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER . TELEPHONE <br /> VEPt%HfONE fD wQ.—SNSoS 7C- —)kMy6,- 2 <br /> MAILING ADDRESS <br /> nA <br /> V� 0 <br /> PROPERTY ADDRESS 26378 S1-..mea �>�`• ` � ) U ^ <br /> U <br /> LEGAL DESCRIPTION 0 aO - O4 3 33- 04 300 y <br /> Pu <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION 10 STAIRS Cl 0 <br /> TYPE OF PERMIT(S): ,o <br /> FILLING/GRADING [I CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ � <br /> STRUCTURE/ADDITION USE: C ..)".'n z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> r— ) S <br /> BUILDING CONTRACTOR: SPI; d— LeC . G"5 0) Qj -i-{ <br /> T t Vv <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 '/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n ?-� <br /> rn <br /> WILL BE RETURNED. < <br /> o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW [ o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). }U 1 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) S, S�u e <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 9J 93 <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 c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C7 W o C 7 <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. p <br /> -3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN •F <br /> NEEDED. ( W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: w LIQ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Y <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. bi <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER Q� i <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I � IC> <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 090R! <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge z y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information c 2 > <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be railed upon by the County of Burnett Wisconsin In determining whether to issue a permit. I further accept all C N—U N ^' .d <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 In O ^S 8 C" <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- 8 CI <br /> described promises at any reasonab time for the purpose of Inspection. <br /> OWNER'S SIGNATURE e ff c 2 <br /> date) ca: B c K7 <br /> ZONING ADMINISTRATO <br /> TOWNSHIP PERMITS MAY BE REQUIRED N` _ <br /> v W O N Vy <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> N o �o <br />