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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Admin strator R z <br /> APPLICATION FOf LAND USE PERMITS or <br /> Rc <br /> OWNER e { e TELEPHONE a <br /> G.� �i <br /> MAILING ADDRESS -� O <br /> S-Za e ran f -q,w <br /> PROPERTY ADDRESSfw.� g5'o d 1 <br /> �O a J <br /> LEGAL DESCRIPTION < w <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ DDITION rAIRS ❑ (� o <br /> TYPE OF PERMIT(S): 9 <br /> FILLING/GRADING❑ CAMPING UN ❑ BUNK798SE q 59.692(1V)GAZEBO ❑ D CK ❑ ^ <br /> 1� / N7nG(oo/Plun.bi aha✓e privy <br /> STRUCTURE/ADDITION USE: JTd e'/ v 65i-fr hr 'S - w Z <br /> Kn (Home/C bin; Comm rcial Business; Bedr m: Deck; c.) -&)cf <br /> BUILDING CONTRACTOR: _!✓ Q �YQ r —_— <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEJ OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLC T PLANS ,t H .b <br /> WILL BE RETURNED. x v 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VIEW) O C^ <br /> T <br /> �. ` fro <br /> 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <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, <br /> AND INDICATE NORTH (N). Ob <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) �. <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASL REMENT(S)TO THE ORDINARY HIGH WATER MARK �. S <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WET AND AREAS,AND (D)LOT DIMENSIONS. oh'O w Z <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. <br /> O <br /> 5. 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 _ y <br /> PLANS MUST BE SIGNED AND DATED BY THE OVINER. - <br /> ti <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. � O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED B LOW: Z 5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQREMENTS WITHIN 60 DAYS OF PERMIT. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETAT ON IS RESTRICTED ALONG SHORELINE. i� I` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARf ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WAL , ETC.,ALLOWED WITHIN THE REQUIRED WATERI(rf` <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLWW FOR PRIVATE RESIDENTIAL GARAGEISTORAC E ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> 7. 370 aw. 7 <br /> I declare that this application(Including any accompanying ached le)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I an responsible for the detail and accuracy of all informat on c _ <br /> contained in this application(including any accompanying schedul )and I further declare that I recognize that this inform 3tion 1 .� « « 7 <br /> am providing will be relied upon by the County of Burnett Wiscon In In determining whether to Issue a permit I further a cept all <br /> liability that may be a result of the County of Burnett relying on if iis Information 1 am providing In this application. I agre to ` <br /> permit county officials charged with administrating county ordina ces or other authorized person to have access to the ab ve- o k n <br /> described premises at any reasonab time for the Durpose of Ins ec[ion. a ^ F > <br /> �JR g <br /> OWNER'S SIGNATURE -0/ 0 ^ S 2 <br /> (date) Z H ' $ sew tr1 <br /> ZONING ADMINISTRATOR <br /> V 111 I <br /> el <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONI YEAR FROM DATE OF ISSUANCE <br /> �ew��f 1�1 �e maiIzd av-w, Lsc,� q-cE_ <br />