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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator - z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> 17e <br /> MAILING ADDRESS 9 �L �x/ j3 <br /> O� <br /> PROPERTY ADDRESS ;2 7 -3 " A?; <br /> �C x <br /> LEGAL DESCRIPTION J <br /> to? CS-m 12) L.3 4o-r 24 - 'f)/0 -/G <br /> SINGLE FAMILY DWELLING 0 GA GE/ACCESSORY STRUCTURE O ADDITION 0 STAIRS Cl g g 4 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO O DECK 0 <br /> STRUCTURE/ADDITION USE: 6 .30 36 3 <br /> Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: — SO Si tt�%O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHE OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. O i <br /> F <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TC P VIEW) — <br /> � � W <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES 10 BE SHOWN OR DRAWN TO SCALE. rr'1 f <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB), INCLUDING Df CKS,PORCHES AND OTHER STRUCTURES, rT, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOW[ G: (A) BUILDING(S)TO ALL LOT LINES, (B) BUIILOING(S) n <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEA UREMENT(S)TO THE ORDINARY HIGH WATER MARK � 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WE LAND AREAS,AND(D)LOT DIMENSIONS. n Ta <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DISTANCES c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. n' G <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. — X� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE D <br /> PLANS MUST BE SIGNED AND DATED BY THE CWNER. IZ> <br /> l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BESTAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. I t� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTEDBELOW: \ O <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. m 3 ; <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETA ION IS RESTRICTED ALONG SHORELINE. n <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 WATER (1`r <br /> SETBACK AREA. I d <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 0 <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> >ns-> <br /> 7. n Y35 Grt <br /> 1 declare that this applicatiod(including any accompanying sche ule)has been examined by me and to the best of my kn wledge �C'n <br /> and belief K k true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informat�ion '- <br /> contained in this application(including any accompanying ached le)and I further declare that I recognize that this informaoon 1 .2 > <br /> am providing will be relied upon by the County of Burnett Wisco sin In determining whether to Issue a permit I further accept all _ <br /> Inability that may be a result of the County of Burnett relying on his Information I am providing In this application. I agrele to C 5 <br /> permit county officials charged with administrating county ordim xn or other authorized person to have access to the above- a �o <br /> described premises at any reasonable time for the purpose of In pection. E ^w w m y <br /> OWNER'S SIGNATURE / -f//� <br /> (date) Z N na •n <br /> ZONING ADMINISTRATOR <br /> F i <br /> TOWNSHIP PERMIT MAY BE REQUIRED ? p »N«w <br /> THIS PERMIT SHALL EXPIRE ON YEAR FROM DATE OF ISSUANCE O w € M <br /> �r d up 6y �2 <br />