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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 /> OWNSRTF,-k—v -:17 Me� ���� TELEPHONE 7ILr k 916,— 17so <br /> MAILING ADDRESS <br /> i <br /> PROPERTY ADDRESS -0q3 <br /> LEGAL DESCRIPTION <br /> r a. <br /> DWELLING/BUILDING D GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS ❑ re <br /> N <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADIINNG U CAAMPIN�G UUNIIT /O BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK nE= ¢ <br /> STRUCTURE/ADDITION USE: IRCK R�LL/7 f D.J _ Z <br /> (Home//Cabin; Commercial Business; Bedroom; Deck; etc.) �/� _ S <br /> BUILDING CONTRACTOR:T L✓I/�.F]L ODi•j _/i/L-- GJA2K Vse-/'r• <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h%11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS m h <br /> WILL BE RETURNED. r� le( � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n <br /> O Si�- Ct 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR D15TANCES TO BE SHOWN OR DRAWN TO SCALE. n p - <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW El 9 W .^.. <br /> BUILDINGS/STRUCTURES (NS),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, y <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OFTHE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 'O 3 <br /> 14- <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Y <br /> (OHWM)OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> F <br /> 4. SHOW THE LOCATION E WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (or),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS,, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO GRADED 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. i ��Caq <br /> j�1 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 2 1 ' <br /> NEEDED. — x <br /> ° I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 4]l- <br /> 1. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. > <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. K <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. :, Q <br /> S. ACCESSORY STRUC11RE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> ^ py >rciu uv <br /> 7. TA p3F w' <br /> 9 m 5'o <br /> I declare that this applicatlon(Including any accompanying schedule)has been examined by me and to the best of my knowledge 9 <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuraq of all Infornabon c p 2=' 1 Y <br /> contained In this application(including any accompanying schedule)and I further declare that 1 recognize that this Information I <br /> am providing will be railed upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 further accept all <br /> liability that may be a result of Ne County of Burnett relying on this Information I am providing in this application. I agree to .r. <br /> permit county officials charged with administrating county ordinances or other autharized person to have access to the above- (} <br /> described premises at any reasonable time for the purpose of Inspeetlon. N n s <br /> & p c <br /> SIGN HERE <br /> 9n--e--ttutre of owner of ming contractor) (date) <br /> rE <br /> ZONING ADMINISTRATOR �J L� a� E' <br /> 4 - <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> rmr� lokr- Piaed tv bt,/ �J-ef7l� Meld l re_ '7-11 off, <br />