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7. <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator it <br /> APPLICATION FOR LAND USE PERMITS a GJ <br /> -705-- 86G-8535_ <br /> OWNER Ja�f� J� Jn CO\ -7 A 6 <br /> V , U N on TELEPHONE 05-- 8(„/ S53S <br /> MAILING ADDRESS D �IJJ lS U EA � Nh b �rVyV1� I- �,, <br /> YJ <br /> PROPERTY ADDRESS �`-� <br /> LEGAL DESCRIPTION <br /> Sai TVoN 1 o J <br /> R �6 ^..+uo I CL Coi / Ld�. y <br /> TYPE OF PERMIT(5): <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ �. <br /> n, <br /> FILLING/GRADING ❑ CAMPING NIT❑ BUNKHOUSE 0 A59.692(1V)GAZEBO ❑ DECKX <br /> STRUCTURE/ADDITION USE: I <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) I z <br /> o <br /> BUILDING CONTRACTOR: <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. A < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. f1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C I m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, "° o <br /> AND INDICATE NORTH (N). v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <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. �' Q <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. - <br /> S. 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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> L1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. � <br /> -1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 4 <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER zy S <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> ^ <br /> [declare that this application(Indytanm atyro <br /> (Including any accompanying schedule)has been examined by me and to the best of my knowledge s , g dP c R n <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 3c $ <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all y o 9 y <br /> liability that may be a result of the County of Burnett relying an 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- $ b yy <br /> described premises at any me able time for the purpose of inspection. j, $ b� <br /> U7/0 r <br /> OWNER'S SIGNATOR °y ,� y s= > <br /> 6 0 <br /> (date) � n �B �� <br /> ZONING ADMINISTRATOR J 'm <br /> TOWNSHIP PERMITS MAY BE REQUIRED a ;^ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Perm; d 1e-4*r '0r6'k ed uP by Sarze 7Qcohso h s W <br /> N HNtHi <br />