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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P <br /> APPLICATION FOR LAND USE PERMITS C� <br /> y y <br /> OWNER — // /4 le TELEPHONES <br /> MAILING ADDRESS IV---I lar/C t S/ _ WhIle <br /> Ra ,, k vQ4 <br /> /U (1ki <br /> PROPERTY ADDRESS <br /> S <br /> j�� I O <br /> LEGAL DESCRIPTION V �L � a Se 1 l W P VV <- <br /> SINGLE FAMILY DWELLINGX. GARA EIACCESSORY STRUCTURE ❑ ADDITION ❑ STAIIS ❑ <br /> TYPE OF PERMIT(S); V 1 n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK❑ r <br /> Rep(Zce w%th s✓hndl de /cl _. <br /> STRUCTURE/ADDITION USE: 2ernU(w PXiS�sa� - �PGIC- <br /> (Home/ !bin, Commercial Business; Bedroom; Deck; etc.) Gz l2. <br /> 7 <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yk X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT LANS C <br /> WILL BE RETURNED. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C �w <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, to <br /> AND INDICATE NORTH (N). i <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDI G(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK(OHWv <br /> 4. SHOW MT EFLOCATIONREAM OR RIVER AND OF THE WELL(W)S SEPTIC TANK(ST), DANDDRAINF ELLD(D)I AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. O0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �? o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE S. OOO <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 M HEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. nn <br /> 6. W R aR3�R$g m <br /> 7. f �e �w a Ir g <br /> I dedare that this application(including any accompanying schedule)has been examined by me and to the best of my knowdge , <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accerecy of all Information e �? <br /> contained In this application(including any acoompanying schedule)and I further declare that I recognize that this Infornnau n I <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I further acma pt all O�N$ U N$ r <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the abov - � rn 21 n <br /> described premises at any reasonable time for the purpose of inspection. <br /> e <br /> pT sz <br /> OWNER'S SIGNATURE � � �' e97 (date) H i Cog <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL IXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> y N O V U O <br /> �� fy1gf'CA I-afi n 8-13-07 <br />