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M' _n SCANNED <br /> z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS N: y <br /> O y <br /> OWNER �I�,i•, w� A 10 TELEPHONE <br /> f U/L /�/ Vlfl rp <br /> MAILING ADDRESS l�b a I - 6f <br /> 5" - 1. 1 Sa ilk4 e 5-53 <br /> PROPERTY ADDRESS a a� 3f-�/ r)r Lso" Ica( <br /> LEGAL DESCRIPTION o <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS 0 .. S <br /> TYPE OF PERMIT(S): �P.' 4, <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK. b <br /> STRUCTURE/ADDITION USE: <br /> �2 W) �GJ ro 03 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) z <br /> BUILDING CONTRACTOR: <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � � <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 9 <br /> I. 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 C <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). t� v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <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. 5 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES p p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. 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 n �' <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I/N1 <br /> W = <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: C <br /> F1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. [i r <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 z <br /> SETBACK AREA. a <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <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 n w n <br /> and belief It Is We,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information w ^ v e <br /> contained in this application(Including any accompanying schedule)and I further declare that I 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 further accept all <br /> liability that may be a result of the County of Burnett relying on this information 1 am providing In this application. I agree to 2' <br /> permit county officials charged with admini g county ordinanc ther authorized person to have access to the above- & + <br /> desaibetl premises at any reason r the purpose of Ins n. <br /> OWNER'S SIGNATURE <br /> n (date) 3 n $ n <br /> ZONING ADMINISTRATOR J I m VLn(" Iti/7 (7 v' �n„ n O z <br /> _ �Al <br /> mesas <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE^ '/�I//; �� y <br /> 'flee /} .}1� I I n J/Y�, IGCC V` C1y^1� 1. Iy� lNV✓ a L <br /> 1 l// I )� I 4 4 C- 7 TL- d � V' NNVV/ L N O H N U <br /> 3-a8- off oN � o <br />