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n z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrato a <br /> APPLICATION FOR LAND USE PERMITS _: y <br /> J � <br /> 6 <br /> OWNER (C kci-u� �- -Y- . 7l. �a I TELEPHONE <br /> / �� (� ( O <br /> MAILING ADDRESS I�I 5V'�Q 'j 0n ,f S� l ( UL4e1-S"�Pr W-1- <br /> i5_L O c)p <br /> PROPERTY ADDRESS 1 <br /> < �' <br /> lin. C� <br /> r <br /> LEGAL DESCRIPTION '^ S <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS6 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT /BUNKHOUSE O 59.692(1V)GAZEBO ❑ DECK ❑ .a �- <br /> r <br /> STRUCTURE/ADDITION USE: <br /> (Yl0✓lAns Cern <br /> (Home/Cabin; Commercial Business; Bedroom; eck; etc.) O c <br /> BUILDING CONTRACTOR: �) <br /> y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAN Ci <br /> WILL BE RETURNED. O o 15:: <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c A <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 In <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) N i Z <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. w' <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. OQ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. - n' m —C_ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Ujw <br /> Uj <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 011 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. rPc t' Y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. B d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER z z <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 /> 7. E <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge T E E <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I 2 1,20 ' > <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. i further accept all C m <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- <br /> described premises at any reasonable time for the purpose of Inspection. <br /> � �,I �] Q N M <br /> OWNER'S SIGNATURE.�u�,CJP& 1 0 / O (J m w n y =? <br /> (date) <br /> T <br /> ZONING ADMINISTRATOR26q, M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE ISSUANCE v <br /> tltn <br /> NOri �mi-e- rucm,belr 1-5` 4 r -&wo F, ti U <br /> Ca-� <br /> uers <br /> icte'r- 0 <br />