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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Adminlstrator 9 z <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER�CrF. TELEPHONE <br /> LL g <br /> MAILING ADDRESS l O 13- 0 h0e Lade <br /> � n <br /> �.W 1P Drl(1�� ( ('O1I Pi ! n d <br /> PROPERTY ADDRESS I-A"KE -kb <br /> s <br /> �izr o Go✓ Lor z Sfc zo Ta> ,uriy d lea �Q Qt <br /> LEGAL DESCRIPTION a esm V, <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE❑ ADDITION ❑ STAIRS ❑ e <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADIN,GI ❑ CAMPPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK❑ 11Y� <br /> IVP/�) �)ll) �l i A ' <br /> STRUCTURE/ADDITION USE: z <br /> ((H�ome--t�abin• Commercial Bu ness; Bedroom; Deck; etc.) c P <br /> BUILDING CONTRACTOR: � Mlc rr / <br /> r b <br /> A PLOT PLAN MUST BE PROVIDED ON AN B 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOTPLANS c <br /> WILL BE RETURNED. I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <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 C O o <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). ,y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) I n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK a <br /> (OHWM)OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF), AND ALL DISTANCES r z o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. pT ILLL���- O <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n £ E <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 9 <br /> m <br /> 0 <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 PERMr,S NOT TO BE USED OR HUMAN HABITATION,ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. eO/1f-n4 Sf� -0s (P q!s;I <br /> 7. T m Q g T <br /> � Cil <br /> 1 derJare that thisapplication(Indudinq any accompanying schedule)has been examined by me and to the best of my knowledge Q�R � ► <br /> and belief It is true,correct and complete. I acknowledge 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 I & �' Y <br /> am providing will be rolled upon by the County of Burnett Wisconsin In determining whether to Issue a permit 1 further accept all v in=W ti b <br /> liability that may be a result of the County of Burnett relying on this Information 1 am providing In this application. 1 agree to a n$ N $ r <br /> Permit warty officials charged with adminlatratlnq county ordinances or other autlwrized parson fo have access to the above- S <br /> described premises a�reasona me foth <br /> r e purpose of Inspection. m y y a <br /> /T 6 ;Fj <br /> SIGN HERE 1�>/ —f 6A��� _� / a ,sy g iy -�p <br /> (signature of own or building contractor) } j 'fib r_., e0i �y_ z <br /> -- � �� ;�^ l .2 rA a _ <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY QUIRED200/, N; H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FRO§.DA ETT COUNTY OF ISSUANCE v w g N U o <br /> erml �� �t SQAdr p ll 10_1 NG <br />