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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( n z <br /> APPLICATION FOR LAND USE PERMITS <br /> 3: � <br /> Z . <br /> �-r� J�'" r n <br /> OWNER,gAf,,qH K/L� ,/j Eb C.IC9E '/L TELEPHONE 715 -327- TZ <br /> n <br /> MAILINGADDRESS 11335- MoqTT3onJ koc:�t Zjt ,� LJT <br /> C ., s`/ S5_3 V 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION m '14 /y c�., S 2 M U % N <br /> s L2yier�✓)1aFfsQx p oP2(hQS� <br /> TYPE OF PERMIT(S); <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 9 ADDITION 0 STAIRS 0 <br /> � <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK El <br /> STRUCTURE/ADDITION USE: 'Satkno - z 7 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o P <br /> BUILDING CONTRACTOR: ©wJ"LCy- <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> WILL BE RETURNED. O <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. inn d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y ' <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING($) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 3 <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 �. ti c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 81 <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. 3 -C <br /> —1 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN l <br /> NEEDED. W <br /> THIS PERMIT 1S SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <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. 9 <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. F <br /> 6. <br /> ^ ;gW> ro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowlgdge <br /> and belief R le true,correct and complete. I acknowledge that I am responsible for the detail and accoracy of all Information e - <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I �� H <br /> H <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 I am providing In this application. I agree to <br /> o c O N S <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above. 8 <br /> described premises at any reasonable time for the purpose of Inspection. <br /> OWNER'S SIGNATURE <br /> (date) <br /> Asa _. <br /> ZONING ADMINISTRATOR JM 4 df)1* <br /> i P i <br /> M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N : <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> O ,nNO <br />