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ON COMPUTEWSCANNED <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator to R o <br /> APPLICATION FOR LAND USE PERMITSCr <br /> OWNER 2 �!! C /, TELEPHONE <br /> �( C <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS 7 ri 1( <br /> LEGAL DESCRIPTIO <br /> � � <br /> f ./ n J4 <br /> I�D <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS 0 b <br /> TYP OF PERMTr(S): V <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE O 59.692(1V)GAZEBO 0 DECK 0 " <br /> STRUCTURE/ADDITION USE: Z <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) o <br /> BUILDING CONTRACTOR: /-}—f - /fl s Gz ' �� C <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAP R. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> O <br /> WILL BE RETURNED. � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C Q <br /> * G 1 <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 v <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). i l>, <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) &) "s) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Fd o3 .� <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND(0)LOT DIMENSIONS. n ;�, (D C" <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (OF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 92 <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 OWNER. = w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 4v <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r Z o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. x 1 O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n_ Ql� <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. IIIN� <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. 7C >in XG> E <br /> n n HIS <br /> IS `^ <br /> 7. <br /> 7 <br /> I declare that this applicatrori(including any accompanying schedule)has been examined by me and to the best of my knowledge z o •I <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information 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 E. <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 C <br /> permit county ofricii charged wl ministrating coun ordinances or other authorized person to have access to the above- n <br /> described premises at any reason ble time for the pur se specti c Cit <br /> 4 <br /> a � <br /> � Y� <br /> 74 <br /> OWNER'S SIGNATURE , c° $= j c <br /> ( at H : o •� <br /> g � S w N1 <br /> ZONING ADMINISTRATOR <br /> C <br /> c <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ N <br />