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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c 0z <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER v eT �'C7�P�1'Ct ,KI yIS�I TELEPHONE ^ <br /> l7 <br /> MAILING ADDRESS <br /> Y)1Gj SSIJso W <br /> PROPERTY ADDRESS a2ggOZ Bonner- ' ^L_ 0060 _ IDN izL'�.t (AJC 5qg 13 <br /> LEGAL DESCRIPTION at.0 r"µC I'C n <br /> S24 T't0N QSW /otZ CSn1 VN ION L." &wi.o+-3� <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT 9�`BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 DECK ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o o <br /> BUILDING CONTRACTOR: n , <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 hh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARiAI OR TOP VIEW) 0 2 T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. rl raC­ (� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW K �' <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) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) C] <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) <br /> F OR RIVER AND WETLAND AREAS,AND (D) LOT <br /> 4. SHOW THE OFfTHE WELL(W)SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. g <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t7 A) o C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR,D. THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. -1 <br /> (� GTHIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: 91 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMTi. <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. [n <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 /> 6. C <br /> NOT TO BE USED FOR HUMAN HABITATION. F C <br /> 7. ^ 'pA >nw 0Y b <br /> 050 ro <br /> [declare that this application(Including any accompanying schedule)has been examined B 9 <br /> and belief It Is true,correct and complete. I acknowledge that I am by me and to the best of my knowledge R z y e H <br /> contained In this application(including an aaom y gg )responsible for the detail and accuracy of all Information _ <br /> PP ( g y pan In schedule and I further declare that I recognize that this Information I <br /> am Providing Will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all vN d'5o <br /> liability Mres <br /> at may be a mutt of the County of Burnett relying on this Information I am providing In this application. I agree to o <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o <br /> described premises at any reasonable e for the rpose of Inspection. m w r1 <br /> n >eY <br /> OWNER'S SIGNATURE �i� Yy S g I O <br /> NHa z <br /> i m 0-0 c'0►�y� <br /> (date) e <br /> ZONING ADMINISTRATOR ^ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> W O W N U <br />