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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administratorz <br /> APPLICATION FOR LAND USE PERMITS 0}1 <br /> y y <br /> tl U- <br /> OWNE \ , TELEPHONE&s�� d <br /> i�� l ai /1a53 � = a <br /> MAILING ADDRESSISS I^ 1 to <br /> [ <br /> �i <br /> v 5 i <br /> PROPERTY ADDRESS/11 _'"SGT `11 i ,.-� <-/j 1{a-. /qv��- -L� �\ A 1/ 0 1 O <br /> LEGAL DESCRIPTIONIIIIII�())�1 It -ran 657 PtJM4 p- �,. <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): -1�- <br /> FILLING/GRADDING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: �rn rQ- <br /> (Home Cabin; Commercial Business; Bedroom; Deck; etc.) 2 <br /> BUILDING CONTRACTOR: �r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> a <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 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N v, <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE , -..0 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (/U <br /> THIS PERMIT IS SUB3ECi TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n C <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 C>q <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 /> nnmo> o -0 <br /> 7. <br /> 39 <br /> I dedare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge g z y c^ y <br /> and belief R Is true,oorrect and complete. I admowledge 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 /> d <br /> am liability <br /> that ay be relied upon by the county r Burnett Wisconsin In determining r to issue a K. I further accept all a a m U c N U o <br /> liability that maybe a result of the County of Burnett relying on this infarnation I a P di In Ilcatlon. I agree to „ <br /> permit county officials charged with administrating county ordinances or Other auth a access to the above- B n <br /> described premises at an a time for the purpose of inspection. w c = Y <br /> 5 .�" N _. <br /> �k <br /> OWNER'S SIGNA RE 29 <br /> o A o > Z <br /> ZONING ADMINISTRATOR Jfm FIai��Goo <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^' <br /> vW OyNV�i <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> m4l-A -I-b P-odiw/� sdh�7 <br />