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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> N y <br /> OWNERnn - o <br /> d <br /> 1\ S t�\ (. G b C,-C Y� TELEPHONE <br /> m <br /> MAILING ADDRESS + U O I_,.1 oJ �� ! _ L. I� ✓ i 1 I L L i� 0T �Q7-- n ""� <br /> 1 El <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION 1"T11 y <br /> DWELLING/BUILDING❑ GARAGE/ACCESSORY STRUCTURE❑ ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): -L <br /> FILLING/GRA ING❑ CAMPING UNIT❑ BUNKHOUSE❑ 59.692(1V)GAZEBO❑ DECK/ n <br /> STRUCTURE/ADDITION USE: �h/ rr�° ODen� �eG�C Citi I�.I� YI6 � '�' c <br /> (`Home/Cabi�d Business; Bedroom; Deck; etc. o <br /> BUILDING CONTRACTOR: <br /> s <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS .sy <br /> WILL BE RETURNED. <br /> O N rn <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> n w <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 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, th a <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) I �' <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �✓ vH <br /> (OHWM)OF LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z' Z <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 /> S. 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. s d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r <br /> NEEDED. <br /> THIS PERMIT IS SU53ECT TO ALL CONDITIONS LISTED BELOW: 5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMrr. n ° <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. '< 3 <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. <br /> NOT TO BE USED FOR HUMAN HABITATION.DD �� '��" <br /> 6• [ ,k 'ft' h _ OpeA, - NO Ko0� Lu64t�w <br /> /' �ai � aoro <br /> 7. .��/ � ewe H 5.N y c E: <br /> C dfl� !t/c1 7t '61 a J.5�'o �w 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 cog»; <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this Information I cn s,N b <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all o. F r o N N Op Cv <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 permit F n <br /> county officials charged with administrating county ordinances or other authorized person to have access to the above-described S is A <br /> premises at any reasonable time for the purpose of inspection. 3 C�, c 2221 y <br /> =� 0 <br /> SIGN HERE _� ♦.._. �—. R,. .___,,ti—�" < <br /> < Z_ <br /> (sig a of e f ilding contractor) (date) J 5n 8 a S' t�z1 <br /> ZONING ADMINISTRATOR c <br /> 0 <br /> c <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> rol <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w <br /> O N U O <br /> �m�k 4- Ie-I� p,b -eco �� �H t2ot /t 7r��obson ' Ig-06 <br />