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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS a t� <br /> OWNER TELEPHONE��3 <br /> MAILING ADDRESS / �;VA <br /> f IU c.rh-, �d� ,A A' F�a� O <br /> a��'��-� fC� ' Ir 11v -1 � � <br /> PROPERTY ADDRESS <br /> Lri 7 4- b'o — 81 v v¢n( � ,'�ro n tU ► t�ea" l <br /> r <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING ❑ GARAGE/A ESS STRU URER ADDITION ❑ AIRS O o <br /> TYPE OF PERMIT(S): — v <br /> FILLING/GRADING C❑_J CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK 11J l T, <br /> STRUCTURE/ADDITION USE: Dran/, bu l(/�1,[{�j Gj 'Z <br /> (Home/Cabin; Cbmmercial Businekadbed room; Deck; etc.) 07 ,or, . <br /> BUILDING CONTRACTOR: OQ r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'k X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS .r, rnn pl <br /> WILL BE RETURNED. O <br /> 0 <br /> S <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnf d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW c :; <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, M <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 9.J o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK DO ,o <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 o <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 a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. �. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN '4) <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: O G; 0 <br /> r Z p <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. 1 <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 yl (_R- <br /> C <br /> SETBACK AREA. \ L. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. <br /> 7. <br /> •O �0=G C y � USO Fi <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge w •� C <br /> and belief it Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all information a o ° y <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 relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all (s R n <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 FF— GI'o `^ "' r <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- S <br /> described premises at any reasonable time for the purpose of Inspection. p m n <br /> _ !=.? S. <br /> OWNER'S SIGNATURE Uit�.r. ['/� .. c m _, S a '0�' <br /> '�� (date) .. p g a c •iy <br /> I `^ <br /> ZONING ADMINISTRATOR �� y6 n9on <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C" <br /> Y�e�mi4- I�-i"'W to c�C"d w� b�j �e%y �Lamo�t -ar7a0 <br />