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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n c <br /> APPLICATION FOR LAND USE PERMITS g I GJ <br /> OWNER TELEPHONE MA2j, <br /> -3 9 -S3q ? <br /> MAILING ADDRESS , <br /> qr1D a <br /> PROPERTY ADDRESS c. R iy\� 0 1 <br /> J � v <br /> LEGAL DESCRIPTION' tj 4, '; 5 ?5 <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE ADDITION 0 STAIRS 0 <br /> TYPE OF PERMIT(S): v p <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 In \ <br /> � 1r� y <br /> STRUCTURE/ADDITION USE: C JZZn I7 1A Cao —I V �O D o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS e W <br /> WILL BE RETURNED. I^ — <br /> O N <br /> DIRECR2ONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � � � � <br /> � 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW w <br /> F <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m 5 y <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) I6p 3 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK e <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 a <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ' 11y� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE at <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 /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> a O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Q � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 3 --3- <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> s � >nm 2: <br /> ,7+.2 <br /> t declare that this application(including any accompanying schedule)has been examined by me and tothe best of my knowledge � �, ,,,a.' <br /> y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information a 2� <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information 1 $ w ;,, <br /> am providing will be rolled upon by the County of Burnett Wisconsin in determining whether bs Issue a permit I further accept all tr ,«.,—;', ^' .p <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 mun ofnd IS charged with administrating eounry ordinances or other authorized person to have access to the above- o f1 <br /> prem at any reasonable time Por the IZ4:a of snap n. to n y m ±r y <br /> (Signa n of ow or building contractor) (dabs) <br /> ZONING ADM99 <br /> INISTRATOR <br /> C y ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 N o <br /> (Cn I e l der R ,6c ISI i) '0stmvV Ae-1 (3,c <br />