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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a a <br /> APPLICATION FOR LAND USE PERMITS <br /> 6 <br /> OWNER, n \I f TELEPHONE <br /> MAILING ADDRES 1 V K <br /> � <br /> PROPERTY ADDRESS!3 b 7 S M V L2j 4 I X< C J <br /> o <br /> LEGAL DESCRIPTION <br /> v, <br /> TYPE OF PERMIT(S): SINGLE FAMILY DWELLING 1:1GARAGE/ACCESSORY STRUCTURE ADDITION [JSTAIRS ❑ P2. <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ r <br /> STRUCTURE/ADDITION USE: h <br /> (Home/Cabin; Commercial <br /> lBBusiness; Bedroom; Deck; etc.) z <br /> BUILDING CONTRACTOR: l__l3vJ <br /> H <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O 3 <br /> WILL BE RETURNED. SIL CG 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <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 C m <br /> BUILDINGS/STRUCTURES (NB),. INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). 3 <br /> .5 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) N 'Z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 0 <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 p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - J <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rn <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 /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. ccV1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CJ CY <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 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. R Z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATIPpN. IJ�t <br /> 6. COrIS' Lk&''hbn MU.S1 ehl✓Id -PQg5 se4- b\j Bufrie-f4Colinl-y2orlrrT5 <br /> 7. bf� ce a+ lob' -<Z+i6a'r-k f,-0m offWim- <br /> F <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge n� 2 a E M <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ^ 'n9 <br /> contained In this application(including any accompanying schedule)and I further declare that 1 recognize that this Information I <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all C a y <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 E..tea' <br /> permit county officials charged with administrating county o nances or other authorized person to have access to the above- <br /> for <br /> described premises at any reasonable[I a the purpo of nspectlon. <br /> a [I <br /> OWNER'S SIGNATURE / a mA _? Y <br /> n,,� r <br /> (date) n n iyi <br /> ZONING ADMINISTRATO m rl a `� h <br /> TOWNSHIP PERMITS MAY BE REQUIRED y v ^ m <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DAIT OF SAN E, <br /> Qeimk d lei Mai l� Se � Yas`�, q-� H <br /> U O y N N <br /> O N to O <br />