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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 /> N N <br /> O e <br /> OWNER f , Er <br /> l TELEPHONE 0 J <br /> K '5[) o� m <br /> MAILING ADDRESS v �- <br /> 888 � ��, �! i C�� #��� I N %��� �� IN I 54g5(o •,° � <br /> PROPERTY ADDRESS <br /> �L f r� 71✓ 1' I V`� 11 � <br /> LEGAL DESCRIPTION <br /> V3� 1/q.' PC Wi'( w.�Sk p �2�' Key-�r�I J p <br /> V" 9 J f ( � � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ I <br /> FILLING/GRADING EDCAMPING UNIT 11BUNKHOUSE El59.692(1V)GAZEBO ❑ DECK ❑ m¢' <br /> STRUCTURE/ADDITION USE: Pole SW z '1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C <br /> WILL BE RETURNED. <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. b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW C7 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, l� w <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK S <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. o , <br /> �, o <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5- <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C? c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE S. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. A ,� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C` <br /> r <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. n <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 R) <br /> SETBACK AREA. p <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> s �yanmQao �o <br /> 7. c <br /> [declare that this application (Including any accompanying schedule)has been examined by me and[o the best of my knowledge d C ^" <br /> and belief i[is true,correct and wmple[e. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained in this application(Including any accompanying schedule)and I further declare[hat I recognize that this information I d 2 Y <br /> am providing will be relied upon by[he 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 G n N o <br /> permit county offlcials charged with administrating county ordinances or other authorized person to have access to the above- S E A <br /> described premises at any re onable time for the purpose of inspection. m i ,{WO �, .,7 <br /> W � <br /> OWNER'S SIGNATURE <br /> c <br /> (date) $ c w <br /> ZONING ADMINISTRATOR i�--) F l Q n cc, <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE CN o U o <br /> R(cn, I-+ le4-kr P(coed ujo 6y rICc,- Smn ) <br />