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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a Z <br /> APPLICATION FOR LAND USE PERMITS N H <br /> s 4 <br /> OWNER (� V'L^a�-. IOW+ Me✓ TELEPHONEr�� _ �26 -1.� 3� o CA <br /> MAILING ADDRESS Z S 3 1 �± 37– R <br /> I y"t J JR <br /> PROPERTY ADDRESS <br /> �pp_�lsS <br /> LEGAL DESCRIPTION loty L0. Lot \ 6 1 <br /> 6E5L 209 /g3q <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION;L DECK O GARAGE/ACCESSORY STRUCTURE Ou\, I ti <br /> BUNKHOUSE O 59.692(1V)GAZE80 k STAIRS O FILLING/GRADING O CAMPING UNIT O <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION O COMMER IAL ACCESSORY STRUCTURE O ^ <br /> STRUCTURE/ADDITION USE: <br /> (Home//Cabin; Commercial Business; Bedroom; Deck; etc.) I Q <br /> BUILDING CONTRACTOR: V C1 <br /> n� <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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, c <br /> AND INDICATE NORTH (N). 4 r, <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) d 'I <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. AJ C? _ ("::> <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES 5 US <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. = y` <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.,THEo <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 7 U a O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN NEEDE <br /> I <br /> l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: b O w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ^ i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER q — O <br /> SETBACK AREA. V <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. F <br /> 7. > 0 0 0 m a O ro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my c 2 ^ ^ ^ $ <br /> knowledge and belief Itis We,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all g ' E d SL a y <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this > > m N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 ^ ?n $S= <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In thisc '� y ; ; = N It <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described <br /> premises at any reasonable time/or the purpose of Inspection. m <br /> 3 K7 ^ y�000$ y <br /> OWNER'S SIGNATURE4Z <br /> ( V > <br /> ZONING ADMINISTRATOR <br /> 2010 <br /> TOWNSHIP PERMITS MAY BE REQUIRED p�� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA1V EINETT C H <br /> 1A�NHy�4'f� <br /> Vut O O p O p <br /> 20NNG <br />