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�) is Y�3 a B q g�AR71-5 C/11 )y INI <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; c <br /> APPLICATION FOR LAND USE PERMITS g I . <br /> }��/ / o <br /> OWNER FSO n nA � f ICES TELEPHONE bs/ 2 ? I �3 <br /> c� n <br /> MAILING ADDRESS 1 aa <br /> �O(o�r'.f <br /> PROPERTY ADDRESS cell d `�s /� Pq T ke r (• J /np n, o <br /> LEGAL DESCRIPTION 5 <br /> DWELLING//BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑/ ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): s �. <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ Iy <br /> STRUCTURE/ADDITION USE: oc d <br /> rr (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) _ J <br /> BUILDING CONTRACTOR: t1c c e CO hSt y�¢3 ' �O /p I A <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +f <br /> WILL BE RETURNED. I^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) g <br /> � 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW r <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3' <br /> AND INDICATE NORTH (N). ("'I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK rX7 <br /> (OHWM)OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. F C c <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES r <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE B <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINWSTRUCRIRE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> e <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> °' Ln <br /> s a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 00 <br /> n i <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. <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¢E USED EPR HUMAN HABITATION. <br /> 6. ��� /OWN iu•'� �S�»i.Go tFO:A`77°'^ /�'/y)E'E� /�1 "/ .JC/✓J�x��4t-/�`!`�4 <br /> O. � ,ya�mRa a <br /> 7. 9 0 = <br /> wC.S <br /> [dedare that this application(inducing any accompanying schedule)has been examined by ma and to the best of my knowledge <br /> and belief It Is we,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o _ <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I S <br /> am providing will be refiled 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 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- 8 <br /> described promises at any reasonable a for the purpose of Inspection, y w m j <br /> !�qq a <br /> SIGN HERE ^ V m <br /> L/In <br /> (sign f owner or bu i contractor) (date) y $6 g <br /> ZONING ADMINISTRATOR g ^` <br /> TOWNSHIP PERMlrrS MAY BE REQUIRED <br /> N - ,M <br /> THIS PERMIT SHALL EXPIRE ONE8U <br /> YEAR FROM DATE OF ISSUANCE Oma, 8 u <br /> r✓ni �� I4�+4e-r mat ��2Cor6ah hvr +j DL.-o6 <br />