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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 a <br /> n <br /> OWNER tTELEPHONE�cGk Ks' n ala -ani - 3(a V/ <br /> MAILING ADDRESS/S C- <br /> l /Q� ST f��L �✓I/✓. ss „ <br /> PROPERTY ADDRESS rI 1 <br /> Li" / � <br /> yV � � Gi J <br /> LEGAL DESCRIPTION <br /> L.oT iS 13,14- <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ S1 AIRS ❑ t <br /> TYPE OF PERMIT(S): ,e <br /> FILLING/GRADING❑ CAMPING UNIT❑ BUNKHOUSE❑ 59.692(1V)GAZEBO O DOCK ❑ —' <br /> STRUCTURE/ADDITION USE: z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o_ <br /> BUILDING CONTRACTOR: E�N'n SO�J C'ON,S//1 UC%-ro�C/ (J70/w W1�/ O� 11 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLO' PLANS H <br /> WILL BE RETURNED. O <br /> p0Si Vie. k C!L o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. to I a (J <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW j C <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) BUILDINGS)TO ALL LOT LINES, (B) BUIL ING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAI K v <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. o z, <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES o, 0 0 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, O ( o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER, CONTRACTOR, ETC.,THE a (� <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 <br /> WHEN <br /> NEEDED. n <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. � i <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. B <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATEf� <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p <br /> NOT TO BE USED FOR HUMAN HABITATION. E Ca <br /> 6. <br /> 7. _ �f <br /> W <br /> I declare that this application(Inducing any accompanying schedule)has been examined by me and to the Desi of my knoi dedge I ;q n y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Informatio Ie <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Informal Ion I <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further aa apt all c N o w v o ti <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 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the abo - 6 <br /> described premises at any reasonable time for the purpose of inspection. w m '_? a <br /> OWNER'S SIGNATURE e:: 94 f� X 6-4-071 <br /> o n g a x <br /> ` (date) F, H; S > <br /> ZONING ADMINISTRATOR � Fta' <br /> TOWNSHIP PERMITS MAY BE REQUIRED _» <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v W G <br />