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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a � z <br /> APPLICATION FOR LAND USE PERMITS o ITIy <br /> OWNER ' ,L ` p 1� N I TELEPHONE�r� <br /> "( <br /> MAILING ADDRESS ']Q9 ^� � 1� 2 S k& �hl rN Sl�j 3C� <br /> V�00 O- J n(.� <br /> PROPERTY ADDRESS o <br /> to-wle- hs A6\le <. <br /> LEGAL DESCRIPTION <br /> 'vl., ✓q I � 'V R W y <br /> TYPE OF PERMIT(S): <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION X STAIRS 0 I �. <br /> g^, <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 ,o <br /> STRUCTURE/ADDITION USE: o n OVw2 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Z <br /> BUILDING CONTRACTOR: JI` eB�.r �aMS�vlcc-�or <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Y2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 C <br /> WILL BE RETURNED. C c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n ii <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. th G <br /> 2. SHOW THE LOCATION AND 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). Ba <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) N i Z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK P <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. R. \ <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES t7 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. - rn <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. c <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN i <br /> NEEDED. O1 y 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: J" ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. R z <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER y <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge n E a U "s <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information R ^ <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wlsconsin in determining whether to Issue a permit. I further accept all <br /> permit mu remises at any reasonable time for the country <br /> of ordinances <br /> or other authorized person to have access to th gree to o <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application I <br /> ed <br /> P ty charged 9 ty P e above- $ ..' D <br /> P Y purpose P � EH�HHNb <br /> OWNER'S SIGNATURE dtV� B <br /> m w m a _ a <br /> �6 ►yi <br /> ZONING ADMINISTRATOR_ �IrII � -Iln � <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1 y^ = _° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF I&UA� <br /> W $ yHj N U <br /> to yto O <br />