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ON COMRUTEWSCANNED <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator C o <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER TELEPHONE l C- J��L,s /'/' <br /> o <br /> MAILING ADDRESS / <br /> 7 1 <br /> PROPERTY ADDRESS 73 <br /> 7 � � �\ <br /> 30 "Ia 1 <br /> LEGAL DESCRIPTION ///&g 7 (V <br /> 'SIZ14 <br /> SINGLE FAMILY DWELLING El GARAGE/ACCESSORY STRUCTURE`,< ADDITION ❑ TAIRS ❑ <br /> TYPE OF PERMIT(S): d <br /> FILLING/GRADIINNG ❑ CAM/PING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: /l ECG I'(��i l ���;(d l Sjn-qV� o �_ <br /> (Home/Cabin; Commercial Busines , Bedroom; ;Deck;; etc.) <br /> BUILDING CONTRACTOR: G�GZI t.1� I/ �CJ <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS ,y <br /> WILL BE RETURNED. C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. l�iJ t7 <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, Cr1 as <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n <br /> 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. a y z <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. v�o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. G c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE f <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> y CJ`i <br /> NEEDED. I <br /> THIS PERMIT IS 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. f� l <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 <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 /> o ynCO J Y C7 TJ <br /> 7. <br /> as <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge �„C <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 /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I „ b <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 m o o <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o <br /> described premises at any reasona le time fDc2 urpose of Inspection. v <br /> Y <br /> 3". <br /> OWNER'S SIGNATURE c m w a z <br /> (date) ys $ ° a <br /> ZONING ADMINISTRATOR �mOar)/ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o <br />