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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 g . <br /> OWNER ' {� TELEPHONE e20 <br /> 1a � herI , vx L' . 1'eerSoVA 71� -g69 -Moq <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS' q S W i S,S, <br /> LEGAL DESCRIPTION j (d) <br /> l to s <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE MI ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): I^ <br /> FILLING/GRAD <br /> ING <br /> ❑ CAMPING UNIIT�❑0 BUNKHOUSE ❑ 59.692(1V)GAZEBO O DECK❑ <br /> STRUCTURE/ADDITION USE: <br /> vla—rGf 3 Y <br /> (Home/Cabin; CoJ rcial'Bu n s/;'B�edroom; Deck; etc.) o P <br /> BUILDING CONTRACTOR: 1-0—u <br /> e <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS e 3s <br /> WILL BE RETURNED. A I^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 N g J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. p O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ro K' `. <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) r: <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK I a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF), AND ALL DISTANCES r <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE B <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> i <br /> NOTE: BUILDING/SiRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. +: c <br /> o m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: e <br /> m <br /> a ) <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. :V <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. -c 3 <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. (� <br /> 6. <br /> 7. <br /> n <br /> [declarethat this application(including any accompanying schedule)has been examined by ma and t0 the best of my knowledge 'y C E <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ^ o <br /> 2 <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 relied upon by the County of Burnett Wisconsin In determining whether to issue a permit I further accept all c V+= <br /> liability that may be a result of the County of Bumett relying on this Information I am providing In this application. I agree to <br /> permit county officals 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. m ^ <br /> HOW <br /> ,rn y <br /> SIGN HERE a g 000 <br /> ( re of owow or building contractor) (date H a 8 a ,n <br /> ZONING ADMINISTRATOR 'm <br /> p o � <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U 8 N o <br /> 4( 1 f4 1 e-t4u r lq-t ed -�o bpi the rC)6 <br />