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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS �. <br /> / n <br /> OWNER leUe Ae / �.6 TELEPHONE 763— 75-Y/ P`{P I o <br /> MAILING ADDRESS I$�' �3 a ti / �U` � �O ti /�!�f� 4 a /✓I e/ SSS/c�� Q 1 <br /> PROPERTY ADDRESS / <' <br /> LEGAL DESCRIPTION L� ZU <br /> s GI 115' <br /> S r S7 <br /> c_ f _ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE O ADDITION ❑ STAIRS W S <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT 0� BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK Cl N <br /> STRUCTURE/ADDITION USE: s"Tk r-s dtOu�) <br /> (Ho//me/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> b <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +f S S <br /> WILL BE RETURNED. p� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 I c O <br /> 3 8 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnf p = 04 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW c I� <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 5' <br /> AND INDICATE NORTH (N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <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 x <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. F <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n J c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE y (� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. ti <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN m t <br /> NEEDED. <br /> m <br /> THIS PERMIT IS SUB)ECi TO ALL CONDITIONS LISTED BELOW: <br /> 5 N <br /> a <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. ? P <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 3 3 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER i <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. <br /> 7. <br /> s � "nIAR g �bg <br /> Lr ': <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and be"e"t <br /> Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information e <br /> contained In this appllcatlon(Including any aaompanylnq sdreduk)and I further declare that I recognize that this Information I ` a <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. i further accept all »=;;; N b <br /> Ilablllit that may be a resuR 0(the County of Burnett relying on this Informaton I am provng in this application. I agree to n `^ g �^ <br /> permit county omclals charged wIM administratlnq wunty ordinances or other authonzed person to have access to the above- <br /> 0 <br /> bove- S <br /> described premises y reasonable tlme for the purpose of InspeRlon. m 5 n m z a <br /> SIGN HERE o x <br /> Is ature of owner or building Fonn�tractor) 'n ) y e S 6 0 <br /> LEE <br /> in <br /> ZONING ADMINISTRATOR (m U.V r( vt/ ) a -a <br /> DT <br /> AUG I ^ 2006 <br /> TOWNSHIP PERMITS MAY BE REQD O »_ <br /> THIS PERMIT SHAL EXPIRE ONE YEAR FROM D iA N o <br /> F4m�-I 4- I,o+� rnacvd �o S levz� N4R UN�rI,l-bt <br />