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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> N � a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERRutl� n r' �a I-Pr TELEPHONy6j-/\ 777_4�� d <br /> MAILING ADDRESS 7pg^- I yV dQ La/e, / yr/�5j�� <br /> Are <br /> PROPERTY ADDRESS �.jb5e. /T�I_e= �5n�e_r, Wi: 5#961 <br /> ALEGAL D SCRIPTION <br /> parel.1 in Goveri nMIfi / Y S a <br /> OF PERMIT(S): SINGLE-FAMILY D ELLING ADDITION DECK❑ GARAGE/ACCESS STRUCTURE ❑ <br /> BUNKHOUSE ❑ S9.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ U <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE O v� <br /> STRUCTURE/ADDITlON USE: 1 � / o <br /> (Home/Cabs ; Commerc I Business; droom; Deck; etc.) <br /> BUILDING CONTRACTOR: Y- <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vt X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS <br /> WILL BE RETURNED. 0r l)) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tl7 CA <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 lora <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, .. B <br /> AND INDICATE NORTH (N). a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) UJ <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ' Q <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. g (� <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ' m \ <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER, k w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. p, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: \)W C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <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. <br /> 7. � a 99 lin pA <br /> g,P <br /> I declare that this application(including any acournPanyin9 schedule)has been euamMhed by me and to the best of my qb F U ao <br /> huo lodge and belief It is true,correct and compiUe. I acknowledge that I am responsible for the detail and accuracy of all R, m e E:_ <br /> adnmhatbn contained In this application(Including any accompanying schedule)and I further declare that I recogntze that this <br /> tKortretbn I am providing will be relied upon by the County of Burrhelt Wisconsin In determining whether to Issue a permN. I <br /> further accept all liability that may be a result of the County of Burnett rely"on this Information I am providing In this � <br /> application. I agree to permit county officials charged with administrating county ordinances or other authortrrd person to have <br /> access to the above-described premises at any reasonable tine for the purpose of Inspection. 5 gto <br /> g rI <br /> OWNER'S SIGNATURE M �. JLVQ.CY/t/ fy cat��D g <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED r <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N U 0 8 <br /> (ef�e�picK(�� �Pb��r, Jc�c(fr6o� E�a;-�o <br />