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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n z <br /> APPLICATION FOR LAND USE PERMITS . (}� <br /> n <br /> OWNER �j L � �oulSe BA( t-Dn TELEPHONE \ a O <br /> MAILING ADDRESS 39 al 1 pth 7iye .S <br /> dl-) DSS ✓hti <br /> PROPERTY ADDRESS + fc)We KOf <br /> a J <br /> LEGAL DESCRIPTION w <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE❑ ADDITION ❑ STAIRS ❑ o 4' <br /> TYPE OF PERMIT(S): ,o <br /> FILLING/GRADING ❑U CAMPING UNIT❑ BUNKHOUSE El59.692(1V)GAZEBO ❑ f �DECK ❑ � <br /> STRUCTURE/ADDrrION USE: I I CJ <br /> '1 <br /> Tl/tPTz S , <br /> (Home/Cabin; Commercial Business; Bedroo ; Deck; etr4 ° <br /> BUILDING CONTRACTOR: clan +e 5 en <br /> S <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS vn, <br /> WILL BE RETURNED. O� < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. enn I� a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW y <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, bt b <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. N �, <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. w' d <br /> S. 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 a. ..� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> —1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' po M <br /> 71 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n � W <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. p <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. (7 <br /> NOT TO BE USED FOR HUMAN HABITATION. Q <br /> 6. <br /> 7. <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 e <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I $ d, <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further accept all ea N= 0 7 <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- B A <br /> described premises at any reasonable time for the purpose of inspection. <br /> OWNER'S SIGNATURE L 't <br /> e c <br /> F( nt can (date) y It <br /> ZONING ADMINISTRATOR ��7m aO. <br /> IJ <br /> O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> y' �H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O N 8 N o <br /> I�P✓()1� `� �P � (Y1CaL�(�^ �b IJP /7 C& r-)6fr1Chzvn L- ')- <br />