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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER 'I/ '.y��C A� TELEPHONE a <br /> MAILING ADDRESS <br /> T4 17 Co fJ A <br /> PROPERTY ADDRESS I g J <br /> e7oK D A � �( ALJ t � r(�`j3 <br /> LEGAL DESCRIPTION <br /> PL.L G L h' Sr� 9 - 7YO/ v <br /> TYPE OF PEPERMIT(S):): <br /> SINGLE FAMILY DWELLING ❑ GARAG&U-t550RY STRUCTURE 0 ADDITIONX, STAIRS 0 c <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 <br /> STRUCTURE/ADDITION USE: Al*Dlvf2 �Tf//�£� S5 ff3o f/ <br /> om Cabi ; Commercial Business; Bedroom; Deck; etc.) 0 0 <br /> BUILDING CONTRACTOR: L A <br /> I^ � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ys X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> p o_ <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 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). Ipo <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) I a <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES ti C o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. g <br /> 5. INDICATE IF A WALKOUT BASEMENT 1S PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. „ S 'mao \} (� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN l <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Y CI <br /> to Q,J <br /> n S <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. " a n <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 I� <br /> SETBACK AREA. I -Z <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. 21111 ll:al <br /> I dedarc that Mu ,correct a (inducting any accompanying schedule)has been eor t e d by me and u the best of-myknowor anon 9e p z y <br /> and belief a ls true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information x <br /> contained m this application(Including any accompanying schedule)and I further declare that 1 recognize that this Information I 8 Y <br /> am providing will be relied upon DY the County of Bumett Wisconsin In determining whether M Issue afurther '^ <br /> liability that may be a result of the County of Bumett retying on this information I am providing In this application. reee apt all m H g N N 8 <br /> permit county officials charged with administrating countyyy--ordinances or other authorized person to have access to Me above <br /> described premises at any reasonable tlm for the purpos R In ectlo ; <br /> OWNER'S SIGNATURE �11 � --'�_07 n <br /> H g�a 11 <br /> Z02 <br /> (date) $ y> <br /> ZONING ADMINISTRATOR �/ La ( ��h _,w tel <br /> vg <br /> IJ <br /> TOWNSHIP PERMITS MAY BE REQUIRED 6t <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA E v N g u U <br /> �.ckc�rd <br />