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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> E <br /> a <br /> OWNER 4A Ur 53,7 J_ I.Y.O � TELEPHONE -) G -`7) F J <br /> ���JJJ n J >T v <br /> MAILINGADORES '7d1 b ' <br /> rAD <br /> PROPERTY ADDRESS ' ��6'1 l/ . I n Q 2 Q a Q b <br /> LEGAL DESCRIPTION /O t n0 �S.{• �Q GN / S �Q yl ° s <br /> 7 /J 7 )t� I U � <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMn"(S): O a <br /> + <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK❑ <br /> STRUCTURE/ADDITION USE: O I1�- t ck ylh C W K- I,8- L C <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Z D <br /> BUILDING CONTRACTOR: CR/✓Ie✓� ° <br /> ,9 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yx X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. C)v CC <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n c G <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 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <br /> AND INDICATE NORTH (N). ,V 5 <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 9/ P <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. Q O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DISTANCES ty <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. PLANS MUST BE SIGNED AND DATED BY THE OWNER.IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE .. <br /> �6 0 <br /> 70 (� <br /> NOTE: BUILDING/S'TRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN Sv <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 9 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r1 o <br /> s C> <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E z O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Q <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge >n m W> 0 V <br /> and belief it Is true,com:ct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ° 19 R '= <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I R '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 C 9 <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 'a CR: y <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 of In on. Q N w,,, o b� <br /> OWNER'S SIGNATURE '-- <br /> ` (date) <br /> ZONING ADMINISTRATOR v 'm F(an'(CI Io <br /> TOWNSHIP PERMITS MAY BE REQUIRED y aw <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> C> <br /> (rnl Ie � 'kms111CcL �2 akrrlskoat's �aw o»tip <br />