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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 <br /> o r <br /> / L g <br /> OWNER TELEPH9M�El4 oW) ss'q <br /> MAILING ADDRESS S�,/ /I /0� /1 /_ `/i/ PP (� �g �Sj��---�`�/ O <br /> L = cig7 o <br /> PROPERTY ADDRESS / ) � <br /> LEGAL DESCRIPTION , <br /> SeL�io^ ,27 OV <br /> -70YO W -14bt�' S ,,� (� <br /> DWELLING/BUILDING r GARAGE/ACCESSORY STRUCTURE r AD ON STAIRS�ff �l 1 <br /> TYPE OF PERMIT(S): /Js5 in 70 P� 10/7r <br /> c `< <br /> FILLING/GRADING r CAMPING UNIT r BUNKHOUSE a 59.692(1V)GAZEBO r DECK <br /> / /fir,MtiN ' <br /> CA <br /> STRUCTURE/ADDITION USE: Ae4 add l /bh .� <br /> C <br /> Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> A /l'� c.7�is, /11r SW � - <br /> BUILDING CONTRACTOR:17-Z DR AZ wU� g(P�p-y7/� <br /> V �-- w <br /> A PLOT PLAN MUST BE PROVIDED ON AN B V.X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. I� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 31 <br /> i ❑ ^ <br /> w O 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. py t7 d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL E)05TING BUILDINGS/STRUCTURES(EB)AND ALL NEW. ❑ !_. <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, try 5. <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS) c <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. " <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCESt" 7O o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c d <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER, v, Q, <br /> o i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN --J3 <br /> NEEDED. <br /> g �I <br /> THIS PERMmIT IS SUB)ECi TO ALL CONDITIONS LISTED BELOW: .b <br /> 5. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n S> \ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. .� K <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER Q <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTUREIGARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. V <br /> NOT TO BE USED FOR HUMAN HABITATIOI* <br /> -5e-e- VC�rrancet qdY <br /> /. <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 <br /> acknowledge that I am responsible for the derail and recognize <br /> of all infomwtion o p g <br /> cerlmlrred in this application(including any accompanying schedule)and I further tletlare that I recagnize that this information I m � <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit I further accept all g. ='w '•' "�' <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 permit rt <br /> ri <br /> county a pals cba withadministrating county ordinances"other authorized person to have access to the above me to <br /> o !~•I <br /> premises at any ren bb time forth purpose of inspection. Q o > <br /> SIGN HERE <br /> gnatue of owner of/building contractor) (dam) 0 e o > 5 <br /> ZONING ADMINISTRATOR jrn Fla r) I�J <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v w S <br /> kfpn-i4 up � ��Hdrnll five l�-�-06 U <br />