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p� f� _11s 3u9 -jig <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS - �3 <br /> OWNER ,� /,J ] �- TELEPHONE '��—//�� —/10 d•y o <br /> MAILING ADDRESS <br /> 2?I471 AoW dlw06.>4 V/l, Sal p93 m � <br /> PROPERTY ADDRESS So,A/VQ <br /> LEGAL DESCRIPTION U Xi & <br /> go J l .L.. .J �CL�a /�9TB J/gggQggg/I�ysxl — _ <br /> SINGLE FAMILY DWELLING❑ GARAGE/ACCESSO Y STRUCTUR ADDITION TA S ❑ 4 " <br /> TYPE OF PERMITS): an�C / W� <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V) ZEBO ❑ DE ❑ <br /> STRUCTURE/ADDITION USE: PH � — z <br /> (HomeXabin; Commercial Bi Bedr m; Deck; etc.) ,J <br /> BUILDING CONTRACTOR: All <br /> .A PLOT PLAN MUST BE PROVIDED ON AN 8 4x X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 3 <br /> WILL BE RETURNED. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) CO <br /> n `o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ot <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW — <br /> OUILDINGS/STRUCTURES (NS), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m <br /> AND INDICATE NORTH (N). b <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) Cl <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Cy < <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. <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. te <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE O q <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> UI y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN G <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDFTIONS LISTED BELOW: ) <br /> I. 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 <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Q <br /> —`NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. 3x >nvcltow <br /> 7. 'to <br /> arm = ""- F <br /> F' > <br /> 1 declare that this apPlKation(including any accompanying schedule)has been examined by me and W the best of my knowledge � <br /> and belief It Is true,correct and complete. I acknowledge that 1 am responsible far me detail and accuracy of all information " c r= w y <br /> contained in this application(including any accompanying schedule)and I further declare mat 1 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 farmer accept all <br /> liability that may be a result of We County of Burnett relying on this Information 1 am providing In this application. 1 agree to <br /> permit county officials charged with administrating county ordinances or other authanzed person to have access to the above- 7, <br /> described premises at any reasonable time for the purpose of Inspection. ac P O c > <br /> Ed <br /> �qx OePsw O <br /> OWNER'S SIGNATURE - " ^g act <br /> _ (date) '- sl <br /> q. k m <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP'PERMITS MAYBE REQUIRED 2 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE O D D OCT 2 9.2013 <br /> BURNETT COUNTY <br /> ZONING <br />