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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator h b z <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER TELEPHONE <br /> yx,CJ' <br /> ��V 1 <br /> C�� Z CIC)( ,e'�3 " <br /> b <br /> MAILING ADDRESS G02_S Ivt <br /> . � I I"""Y���n � <br /> g <br /> PROPERTY ADDRESS <br /> .e- o bkl. CX15SL0kt 1�&kl ( <br /> Q <br /> LEGAL DESCRIPTION <br /> o � C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ o ,� <br /> TYPE OF PERMIT(S): <br /> FILLING/GRA/DING 0 CAMPING UNIT <br /> `0�BUNKHOUSE ❑ 59.6//92(1V)GAZESO ❑ DECK ❑ 1^ <br /> STRUCTURE/ADDITION USE: V CirCgb 5 1 r/Y� Qi 0 `(. <br /> (Home/ bin; Commercial Busine , Bedroom; D k; etc.) <br /> BUILDING CONTRACTOR: J JC(/) �fV ill �� I^ SO <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +� d <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r0 <br /> ui 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tin <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, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O) R <br /> (OHWM) OF LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t? c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 00 <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. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> r z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. jO <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. ! i <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. C G <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. 7d >r�maL%7 <br /> o °; F <br /> I declare that this ,comectapplication(Including any accompanying at I a r has been examined by me arch u the best of my knowledge <br /> and belief lt Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information c <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information i <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all 8 u N g ;y <br /> liability that may be a result of the County of Burnett retying on this Information I am providing In this application. I agree e m Cj� r" <br /> described <br /> county isflclals charged wlth administrating county ordinances or other authorized person to have access to the above- o "' <br /> described premises at any rcamtona le for the rpose of Inspection. N v, m Y <br /> 91 <br /> SIGN HERE_ / <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR C✓'�.A I(•, \ /!V{') ���1/11 Gid f7 ��: ��'o: : py <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE F ISSUANCk dN 8 N o <br />