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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator e n o <br /> APPLICATION FOR LAND USE PERMITS g <br /> OWNER / n , f/ am�O TELEPHONE 'J6/ j qz Sr7� a <br /> / <br /> MAILING ADDRESS /q//t-I D.�n f/p, w7-/ ee - 41VJRtl 03 <br /> a C <br /> PROPERTY ADDRESS X6�9y G <br /> LEGAL DESCRIPTION/0 j*IAl CSJ14 V �� P X 74/ .�����rwty6A � �_ 9. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESS Y STRUCTURE 6—ADDITION STAIRS ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(iV)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: &4A A 3 0 <br /> � ((��(Home�//Cabin, ommercial Business; Bedroom; Deck; etc.) 2 <br /> FT <br /> BUILDING CONTRACTOR: U F"V�,E" ®w/kj�t� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 'n <br /> S w <br /> WILL BE RETURNED. 0 I <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 8. <br /> n o s <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW a S <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). l <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(5)TO ALL LOT LINES, (B) BUILDINGS) r+ o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK jp <br /> (OHWM) OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES m P <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> -5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q 4, o O' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE y XJ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 091 <br /> C 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r3 <br /> NEEDED. Q m (y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c <br /> m � 1 <br /> o w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. } , <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. 3 3 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. q <br /> 6. S � �nmR aK1 <br /> 7. R R R� � e <br /> w 3 <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my knowledge 5 z W g�!+ y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o, <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I2 H <br /> am providing will be relied upon by the County of eumett Wisconsin In determining whether to issue a permit. I further accept all c N g N N g V <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 S n <br /> described premises at y reasonable me for the purpose of Inspection. m ^ e 71 <br /> SIGN HERE /TL( f//// ell 44 on Ai -q'A is 24 <br /> (signature of owner or uulleing cogtractor) (60) Iy : s c 9 <br /> 1 , 1 .� <br /> ZONING ADMINISTRATOR MFlan ti a 1 g <br /> TOWNSHIP PERMITS MAY BE REQUIRED H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FR M ATE OF ISSUANCE U 8 <br /> �2rmi� 1e, o— Lep -o6to C,Pgctl "6h <br />