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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 /> y <br /> OWNER 6Q LA& TELEPHONE qS1 _%o — 477 <br /> MAILING ADDRESS a`kA3 15n4tt)ynsS / J' AA nne' BKAV <br /> JJJIJJ I = <br /> PROPERTY ADDRESS ba I /a /�_ W� <br /> b l 4Shf\ l .ttEWI a <br /> LEGA DESCRIPT ��°�' S�7 2 0 <br /> �� Loi 3 Wj <br /> 5euken3s Idu mhe yl /uof�rh �. )d wPd <br /> SINGLEFAMILY D LLING ❑ GARAGE/ CCESSORY STRUCTURE STAIRS ❑ <br /> TYPE OF PERMIT(S): b <br /> FILLING/GRADING ❑ CAMPING UNIT❑ /BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ ( , , <br /> STRUCTURE/ADDITION USE: AAOK fIA). _ L W <br /> z <br /> (Home/Cabin; Commercial Busines( Begd.�room; Deck; etc.) <br /> BUILDING CONTRACTOR: N6 <br /> ,Lbi04Z ( ✓• Q ° <br /> W � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS A <br /> WILL BE RETURNED. O <br /> o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> � 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tn=f O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW [ w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). (�) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK (�' ,B <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N y <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES a. o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <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. <br /> YJn 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r � <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. n O <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. (3-. <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 /> 9nwOD0 "p <br /> 7. 's0 n ,^0 B o Sc h7 <br /> Cr <br /> w <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information v e <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- c (7 <br /> described premises at any real nab a time for the purpose of inspe Ion. c= > <br /> 5r <br /> OWNER'S SIGNATURE <br /> O N 1 m <br /> date a� y, : �o^ a 9- zy <br /> ZONING ADMINISTRATOR M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N <br /> T IS PERMIT SHA L XPIRE ONE YEAR FROM DATE OF ISSUANCE SUN o <br />