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iII <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ° o <br /> APPLICATION FOR LAND USE PERMITS Z _ <br /> 0 <br /> 6 <br /> OWNER <br /> -TELEPHONE( <br /> MAILING ADDRESS [74 �S(�,e y/ (�/� y� \ Vw <br /> PROPERTY ADDRESS / <br /> 577 Ss <br /> 0 <br /> LEGAL DESCRIPTION `A <br /> SINGLE FAMILY DWELLING ❑ GARAGE CCESSORY STRUCTURE ❑ ADDITION 99 STA RS ❑ c <br /> TYPE OF PERMTT(S): n <br /> FILLING/GRADING ❑ CAMPIING UNIT BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DEC ❑ I T <br /> CA <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commerc al Business; Bedroom; Deck etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET CF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 3 <br /> WILL BE RETURNED. A < <br /> C c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP EW) " S <br /> � 6 <br /> n L <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTINC BUILDINGS/STRUCTURES (EB)AND ALL NEW y I v <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECK 3, PORCHES AND OTHER STRUCTURES, t+n m <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING (A) BUILDING(S)TO ALL LOT LINES, (B) BUIL NG(S) I -> 3 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASU MENT(S)TO THE ORDINARY HIGH WATER MAR e <br /> OR RIVER AND WETLA 4D AREAS,AND (D) LOT DIMENSONS. N <br /> 4. SHOW T EFLOCATION OF THE WELL(W), SEPTIC ANK (ST) AND DRAINFIELD(DF)I AND ALL DISI NCES R y <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 _ <br /> PLANS MUST BE SIGNED AND DATED BY THE OW ER. y <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STA ED SO AN ONSITE VERIFICATION MY BE DONE 14HEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -� <br /> r z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. P,s x <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. & ! I <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS ETC.,ALLOWED WITHIN THE REQUIRED WATE IN <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOWFOR PRIVATE RESIDENTIAL GARAGE/STORAG ONLY. £ <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. sF >n9};, ' O � <br /> ae xRR F <br /> 7. <br /> vC .j <br /> 1 declare that this aDDilcation(Indutling any accompanying schedurp <br /> as been examined by me and to Me best of my lenr-e <br /> Z ^ <br /> and belief It Is true,correct and complete. 1 acknowledge that 1 aonsible for the detall and accuracy of all inform ti o o __= Y <br /> contained in this application(Including any accompanying scheduld I further declare that I recognize that this inform ,� ^ a w w M N .p <br /> am providing will be relied upon by the County of Burnett Wisconsdetermining whether to Issue a permit. I Further a \N a N <br /> liability that may be a result of the County of Burnett relying on th information I am providing In this application. I agre ^ <br /> 171 <br /> permit county officials charged with administrating county ordinan es or other authorized person to have access to the al ve• m y m A <br /> described premises at any reasonable time for the purpose of"p tction. ^ O d c =. -1 <br /> 3 <br /> OWNER'S SIGNATURE (date) vs ; c > 5 +r <br /> ZONING ADMINISTRATOR " �' / 1 F Ian i n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> � �M gWNo <br /> I�P(mi + 1e fir pact d LAID btj 7ban 6bo &-I, <br />