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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERTN <br /> E PHOE <br /> -7�- -S�/fl7/ <br /> MAILING ADDRE S <br /> - - 2750 7`i r'y CT. E7gsT, Tuarx C'/QOUE h�Ts. !'�lrtr SSo7/o <br /> PROPERTY ADDRESS I'RI a Jr �D <br /> 'I'vU o � <br /> LEGAL DESCRIPTION — <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTUR <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAALL„A,DDITION ❑ COMMERCIAL ACCESSORY <br /> STRUCTURED c <br /> STRUCTURE/ADDITION USE: 1 n <br /> 0 <br /> (Home/Cabin; Commercial Business; Be om; Deck; etc.) <br /> BUILDING CONTRACTOR: L <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. 0 e <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW ,+f w o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. I C7 <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. '� m <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 „\ o <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. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C�> <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. i toj Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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 O <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. CQ� <br /> 6. <br /> 7. z o 0 0 0 n d <br /> Ry933 am <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all g, ' m t=: EL EL <br /> Information contained In this application(including any accompanying schedule)and I further declare that 1 recognize that this ,^o E. a 9 m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I c ?w'= .�y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c '� o ;.,N``' t-,N ro <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have o o f. <br /> access to the abovrdescrlbed premises at any reasonable ntime for the purpose of Inspection. 7 rt g o 0 0 o y <br /> > <br /> OWNER'S SIGNATURE_ .�J/G PSL / Sf° > ii m n v, O <br /> (Bate) o a o F3 o G. <br /> ZONING ADMINISTRATOR Meal )Qd2 I y E <br /> TOWNSHIP PERMITS MAY BE REQUIRED A °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> � � 00000 <br />