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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> OWNER AJC-/G� � AM �C71mL4f TELEPHONE <br /> MAILING ADDRREESS O <br /> �bab /�I � f1vc� 1jfor42,j6Pv,'t,l1 55769 <br /> PROPERTYADDRESS L� /C)r1a <br /> / / <br /> LEGAL DESCRIPTION <br /> 0 1 <br /> TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> C� 5 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: Cw i2� z ,5112J <br /> (Home/Cabin; Comme al Business; Bedroom; Deck; etc.) - z <br /> BUILDING CONTRACTOR: <br /> m 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o S <br /> WILL BE RETURNED. 0 - .. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n °' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C O <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, 3 <br /> AND INDICATE NORTH (N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' p <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 p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - y , <br /> S. 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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. {f„ <br /> II <br /> NOTE: BUILDING/STRUClURE 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. n C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a "` <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER y <br /> SETBACK AREA. \ <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. f <br /> 7. ^ ,Ky anOOn apCCpro <br /> Rn m351B 'g EF <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(Including any accompanying schedule)and 1 further declare that I recognize that this " E D 9 m`O <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I a R $a^ a <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providingIn this m ' w ``- ro <br /> application. I agree to permit county officials charged with administrating county ordinances or other auhorizeperson to have �' « i «� <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. 6 ' 8 8 8 <br /> n $o�Noga <br /> OWNER'S SIGNATURE � _" G 1 e �$ <br /> a <br /> _ r =:momtv <br /> y_ O <br /> I� (date) <br /> ZONING ADMINISTRATOR_ <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ON H »H«» <br /> N N $ O O O$ <br /> RrVai4-4 �Pif k�io(c'lce� Lip bgJl7 eXld l ia.-on me PtInw <br /> 3 �-p <br />