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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ? <br /> APPLICATION FOR LAND USE PERMITS 7 <br /> pG <br /> OWNE �- TELEPHONE ,LSA — Ct n <br /> OSWJ1� A.wc`� 1.]1Gw-0- [I.yV— YS )r Sl - .`�� <br /> MAILING ADDRESS <br /> I Z-b) Z 2-Sb`Y� 1"^� SSOj3 <br /> PROPERTY ADDRESSR7r_ <br /> n <br /> LEGAL DESCRIPTION1I g, 4{ Z <br /> NW '1w SW ')y sector 301 7 9) R )S >A1 5. <br /> SINGLE FAMILY DWELLING ZI GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS Cl R R <br /> TYPE OF PERMIr(5): <br /> FILLING/GRADING ❑ CAMPING UNIT�.O BUNKHOUSE LI 59.692(1V)GAZEBO ❑ DECK❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;'Commercial Business; Bedroom; Deck; etc.) <br /> R o <br /> BUILDING CONTRACTOR: _n�f- =�rC�.rn ty— <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS in <br /> C <br /> WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I _ <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). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK(OHWv <br /> ONS. N <br /> 4. SHOWMTHOEFLOCATIONROFhTHOR RIVER E WELL(WN SEPTIC TANKLAND RST)ANDDDRAINO ELLD (DFS,AND ALL DISTANCESJj z' y <br /> o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES, e0 <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, I^ I 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUB3ECT TO ALL COND,'TIONS LISTED BELOW: <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEN.AY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t7 i <br /> 3. NO GRADING OR SHORELAND A-TERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. }- <br /> 4. NO STRUCTURES, INCLUDING R TAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. (} <br /> S. ACCESSORY STRUCTURE/GARAC 2 PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY, <br /> NOT TO BE USED FOR HUMAN H.,"ITATION. f <br /> 6. <br /> an pa o <br /> 7. IT � � <br /> : � � <br /> I declare that this appllnddn(Including any aeeompanylnp schedule)has been examined by me and to the bort of my knowledge <br /> and belief R Is true,correct and complete. I a,xrowledge that I am responsible For the detail and accuracy of all Information <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information 1 ° is <br /> am providing will be relied upon by the Coungf of Bumett Wisconsin In determining whether to Issue a permit. I further accept all N N 8 <br /> liability that may be a result of the County of burnatt relying on this information I am providing in this application. I agree to n 16. <br /> permit county officials charged with adminlstrrbrq county ordinances or other authorized person to have aecaaa to the above- � f1 <br /> described promises at any sonable time the pu se of Inspection. a <br /> � � L — AczY Ll� <br /> OWNER'S SIGNATURE ( c.r-�,']fraJ on n `OL <br /> U (date) I y 0 <br /> ZONING ADMINISTRATOR � <br /> i Sc � P <br /> TOWNSHIP PERMITS MAY BE REQUIRED «` <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N 8 t2 M 8 <br />