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ON COMPUTER/SCANNED <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS a r, <br /> o N <br /> OWNER + TELEPHONE �� 1 ���� `,��ow6a& h04\1110� � amC✓ <br /> MAILING ADDRESS fiAI11r1Q',64k <br /> A'/V JJJ— <br /> PROPERTY ADDRESS Lie ou'�4 0- P _ /� Q <br /> LEGA DESCRIPTI _1_ �— o CA <br /> L�` p1A' / (7t 5C1�f1.3J ����✓)S'Mr y/ �rol7V,, z�ltiy 1 d �tl(�. - <br /> [� WSINGLE FAMILY D LLING ❑ GARAGE/IkCCESSORY STRUCTURE STAIRS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ j z <br /> STRUCTURE/ADDITION USE: Q/LdhL� w z <br /> (Home/Cabin; Commercial Busines Bedroom; Deck; etc.) o fi <br /> BUILDING CONTRACTOR: / 1144,1 O-� 111 0' �J <br /> W <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS �n DO <br /> WILL BE RETURNED. �O C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C c rQ <br /> _a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, tj: fl <br /> AND INDICATE NORTH (N). as V <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n I <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Sb <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. N <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. u=S <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 M. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. = .71 � fl 91 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN V' I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. c� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER IN <br /> SETBACK AREA. <br /> I <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F CN <br /> 6. _ 1 <br /> n a v M CN <br /> 7. �• �QUO C � PO � �\ <br /> I declare that this application(including any accompanying schedule)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 am responsible for the detail and accuracy of all information c y O <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I O <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I further accept all N`=w o ►rod <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 <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 reas a time for the purpose of insp ion. C) y <br /> OWNER'S SIGNATURE X J07 r) <br /> date b9 : � o > 2 �7 <br /> ZONING ADMINISTRATOR <br /> rM <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^f <br /> 6�9 <br /> T ISS`�PERMIT SHA L XPIRE ONE YEAR FROM DATE OF ISSUANCE -� o <br />