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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 /> OWNER JcnJi ( S�moNsenl TELEPHONEI�� <br /> C m <br /> MAILING ADDRESS �(/F� , - 1 n O O ^ I o o <br /> PROPERTY ADDRESS c� /L�Ile- <br /> LEGAL <br /> LEGAL DESCRIPTIONm <br /> NW 1 C) q S c 23 --F3g� _P I jW fi g <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): � b <br /> FILLING/GRADING ❑ CA/M�PING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ n <br /> STRUCTURE/ADDITION USE: ��2�GE-/,�7©!<A{�_ o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o_ <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <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 ci <br /> r71;JJ <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, y <br /> AND INDICATE NORTH (N). Imo" <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 3 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ,z e <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES r� ° <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. Fo O <br /> 5. 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. c <br /> R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. 4Z <br /> 9 Xl <br /> THIS PERMIT IS SUB]ELT TO ALL CONDITIONS LISTED BELOW: <br /> 5" 9 <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. .Kiz <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER �. <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. ! <br /> 6. cy <br /> 7. 39 52m <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledgeg, ,,,c'g 1 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 g' <br /> contained In this application(Including any acoompanying schedule)and I further declare that I recognize that this Information I00 <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permIL I further accept allro <br /> N U c t- <br /> permit <br /> that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to f- <br /> permit county officials changed with administrating county ordinances or other authodzed person to have access to the above- n <br /> described premises at any reasonable time for the purpose of Inspection. <br /> 6' <br /> SIGN HERE �—Z-10— 0 1 <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED « : <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �' ''�ieLedy b'� nfs Simonsen a1 01� <br /> Perm <br />