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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS <br /> Z <br /> ' <br /> e � <br /> OWNER 04 (Lh(V�-LL.L at j t L� TELEPHONE / L YO / 9/fjFj <br /> MAILING ADDRESS 5- d D,/-- I J/LF- �6/Ali¢ '-I )`f SSS/ 7i <br /> PROPERTYADDRESS I�02SESKOL� L/�{G(� - Up��yy/ l�f¢fS Lcff4° (LO _ <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS c <br /> TYPE OF PERMrr(S): n <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ° <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C <br /> WILL BE RETURNED. 70 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VI W) o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING UILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS PORCHES AND OTHER STRUCTURES, w' <br /> AND INDICATE NORTH (N). SU <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASURE ENT(S)TO THE ORDINARY HIGH WATER MARK ,e <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAN 3 AREAS,AND (D) LOT DIMENSIONS. N w <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC T NK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES �. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <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.,THE g. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNE R. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAK D SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS AREA LOWED UNLESS SPECIFICALLY PERMITTED. 8 -� <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 BE USED FOR HUMAN HABITATION. E <br /> 6. p <br /> UMn <br /> 7. rRNr � na R...= � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge , Z w y <br /> and belief R Is true,correct and complete. I acknowledge that I am i mponsible for the detail and accuracy of all Information o ? y <br /> contalned In this application(Including any accompanying schedule) nd I further declare that I recognize that this Information I <br /> am providing will be relled upon by the County of Burnett Wisconsin i determining whether to issue a permit. I further accept all c U$ N N 8 <br /> liability that may be a result of the County of Burnett relying on this iformation I am providing In this application. I agree to <br /> permit county officials charged with administrating co ordinance or other authorized person to have access to the above- 8 ry <br /> described premises at any re so bla tiirep n. P o= y <br /> OWNER'S SIGNATURE_ /zI/G <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS AY BE REQUIRED <br /> H: H: <br /> THIS PERMIT SHALL EXPIRE ONE R FROM DATE OF ISSUANCE N $U <br />