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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Admini trator o <br /> APPLICATION FOR LAND USE PERMITS . CEJ <br /> OWNER �/I _ / ✓W/n S TELEPHONE6 - 7DI- ZO y <br /> MAILING ADDRESS I/" / S4 �J�� n�7/V SS v <br /> PROPERTY ADDRESS /J / ' N� <br /> V LIEGAL DESCRIPTION C CC I 2 t�a v" P 15 <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ST IRS ❑ o T <br /> TYPE OF PERMrT(S): t <br /> FILLING/GRADING//O'' CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DE K❑ 1�, \ <br /> STRUCTURE/ADDITION USE: CS1 194 46G A� r, �z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o —' <br /> BUILDING CONTRACTOR: /-40m, Ow/v('/L- <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOI PLANS <br /> WILL BE RETURNED. <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tn�f O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW c' <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) BUIL ING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAR 99 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. IN <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTkNCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w IQ <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 q_ <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 I VHEN <br /> NEEDED. (/ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r z O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 8 I_ <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p <br /> NOT TO BE USED FOR HUMAN HABITATION. Q <br /> 6. <br /> n <br /> 7. R <br /> 9 g�95 og <br /> HN : � � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge Z w n y <br /> and belief It Is true,correct and complete. [atluwwkdga that I am responsible for the detail and accuracy of all Informatl0 o ? <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 relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all c E N w w 0 7 <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree 18 `"'" C" <br /> permit county o'"Oh' <br /> charged witli m rating county ordinances or other authorized person to have access to the above- <br /> 0 <br /> bo - 8 n <br /> described premises at any re le time Ibr the purpose of Inspection. „ v, _ y <br /> OWNER'S SIGNATURE i /" "- 2 Z I x <br /> (date) w 6 9 �w �y <br /> ^per Pf <br /> ZONING ADMINISTRATOR <br /> R <br /> TOWNSHIP PERMITS MAY BE REQUIRED (DH' <br /> oyN� <br /> THIS PERMIT SHALL IXPIRE ONE YEAR FROM DATE OF ISSUANCE .., <br /> /nrni� I el�le� Jb2( 104- �Ca-f' wt hs �- �5-o`? <br />