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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 a <br /> OWNEP!—'jTl C5MjLe; IoW TELEPHONE (0!Sj br�S <br /> MAILIfJ(( �OADDR <br /> `2i Tf/VL ru0 <br /> PROPERTY ADDRESS��i� I <br /> LEGAL DESCRIPTION n O <br /> FC1' 6DVLr ,(�4 �C< a(o(� JA) 9-& <br /> SINGLE FAMILY DWELLING ❑ GARA E/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ ,ar, <br /> TYPE OF PERMIT(S): ,q <br /> FILLING/GRADING ❑ CAMPING UNIIT 0 BUNKHOUSE 0 <br /> 59.69�2((lV)GAZEBO ❑ DECK 11STRUCTUR �� <br /> ADDITION USE: — rRi mw �/--`C. <br /> -j IS -tel I yK r� 'Z <br /> (Home/Cabin; Commer al Business; Bedroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. O� < <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <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, m w <br /> AND INDICATE NORTH (N). 1 <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 d a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N �, <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. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O c <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. Ql <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 70 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -✓" <br /> r <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. <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F, <br /> 6. <br /> � aHmoaoro <br /> • 000 o_ o <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge n ? y <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information 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 <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to t" <br /> permit county officials charged wi administrating county ordinances or other authorized person to have access to the above- i; <br /> described premises at any above- <br /> re <br /> le time for the purpose of Igspecti ,��, p c = y <br /> r 5 <br /> OWNER'S SIGNATURE IOa <br /> (d te) <br /> y Yy <br /> ZONING ADMINISTRATOR (n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE S o <br />