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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS a <br /> - w <br /> 7� <br /> OWNER ��` Z � � � TELEPHONE <br /> r r <br /> MAILING ADDRESS O <br /> PROPERTY ADDRESS Gibs'' GLN,j uj97--(5GjT0F/2,/ f..Y, 6 _�1 <br /> C) J <br /> LEGAL DESCRIPTION < y <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPINGUNIT❑ BUNKHOUSE 0 <br /> 7.5t9.692(1V)GAZEB/O ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: Z Ifie'rr <br /> /f (Home/Cabin; Commercial Business; Bedroom); Deck; etc.) <br /> / [2 <br /> BUILDING CONTRACTOR: lfN� f' x- —00f<$-A 'V <br /> W � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C <br /> WILL BE RETURNED. < <br /> o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) y o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW ti <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, re w <br /> AND INDICATE NORTH (N). I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK l <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. N ti <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. °a <br /> 5. 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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN .� <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> S O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. y C ' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT*Z ;TOMB./E�USED FOR HUMAN HABITATION. ��p� <br /> 6. /, F 4r AX 0w-V Ab laopj&.S. wV 7� >nm o a ? 'o <br /> 23 FR RnM <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge C^ y <br /> z <br /> and belief It Is true,correct and complete. I acknowledge that t am responsible for the detail and accuracy of all Information ^ 0 2 <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I & ^ : ;,, y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree tol <br /> ^ ct <br /> permit county officials charged with adml la)rating county ordinances or other authorized person to have access to the above- 8 � (") <br /> described premises at any reasonable a or the purpose of Inspection. 3 P c _ y <br /> OWNER'S SIGNATURE ► 1 ���� �° U y a z <br /> m <br /> (date) yr ? _a, --I^ PF &w � <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED a v <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U ^ <br />