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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS I . <br /> H _ <br /> OWNER n <br /> (�P� �n N� TELE/PHONE �C / O <br /> MAILING ADDRESS -,,v(�I C'/ U/V iVi� )CS L��� �Jar� <br /> O a <br /> 0 <br /> PROPERTY ADDRESS //// <br /> a7 FC"oo-uNculS Z<A lP��/e�S7�cvC✓T. 9y i� 5 S�' <br /> LEGAL DESCRIPTION <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS S <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT 11BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ y <br /> STRUCTURE/ADDITION USE: I X Z <br /> (Home/Cabin; Commercial <br /> _Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: :A/�t"��� '"'✓'"td,SG IUB P <br /> s `�1 <br /> A PLOT PLAN MUST BE PROVIDED N AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 5" <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AN 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) -+ J <br /> 3. SHOW DIMENSIONS IN FE FT OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) I I..� (N on <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK G p o <br /> (OHWM) OF LAKE, STREA OR RIVER AND MEASUREMENT TO WETLAND AREAS. z OOn z <br /> 4. SHOW THE LOCATION OF HE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES md P <br /> TO BUILDINGS, ROADS, KE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT EASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c7 o O <br /> 6. IF SEPARATE PLANS ARES BMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE y <br /> PLANS MUST BE SIGNED A D DATED BY THE OWNER. a 0 <br /> 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r <br /> NEEDED. m c -1- <br /> pp m � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 9 n w <br /> m <br /> _' a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF rREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. j P <br /> 3. NO GRADING OR SHORELANID ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDI 4G RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 3 3 <br /> SETBACK AREA. O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. G' <br /> 6. NOT TO BE USED FOR HUM kN HABITATION. p <br /> > � <br /> 7. 2, p. 11.1Fzo: <br /> I declare that this a llcatlon(Including a accompanyingschedule has been examined b me and to the best of m knowledge 9 C <br /> PP ( 9 Y ) Y Y 9 <br /> and belief It Is true,correct and complete I acknowledge that I am responsible for the detall and accuracy of all Information F- 0 2 <br /> contained In this application(Including an accompanying schedule)and I further declare that I recognize that <br /> MIs Information I ^ p 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 to n <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o <br /> described premises at a, y reanaa -le tim for the purpose of Inspection. m gng y y a <br /> F. <br /> SIGN HERE 7 ,� O6 A : S � z <br /> (sign'aat"u�m ffoowner orbuildingcoonnyt,�ractor) (date) H g a <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMTfS MAY BE REQUIRED <br /> v I H H N U <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA CE N 8 u U o <br /> welder <br />