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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g ; z <br /> APPLICATION FOR LAND USE PERMITS : <br /> C C <br /> n <br /> a <br /> OWNER / � <br /> 6�IA46'c `UST# TELEPHONE 8l� <br /> MAILING ADDRESS ")63 <br /> 63 �c�J �D! <br /> PROPERTY ADDRESS/��� / CJC� <br /> < <br /> / o <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION F0 STAIRS ❑ .. �. <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPINNG UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ v <br /> STRUCTURE/ADDITION USE: �?St)-) R- c4f <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c <br /> BUILDING CONTRACTOR: IL C.O O S b j 1I11 11 <br /> y W <br /> A PLOT PLAN MUST BE PROVIDED ON AN B W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. !� c <br /> O 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW r' m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). ,03 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <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. w' <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ti 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE <br /> KV <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. c <br /> nn <br /> NOTE: BUILDING/STRUCfURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN �y I <br /> NEEDED. cc) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 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. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. B z <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER A <br /> SETBACK AREA. I <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> ;, yanmga Oro <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge n n F n By <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information H ^ ;; IT <br /> a <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this infortnatlon I 3 c �, g : S <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all � a y <br /> liability that maybe a result of the County of Burnett relying on this information I am providing In this application. I agree h) n �� <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- $ Hy <br /> described premises at any reasonable time for the/pururrrpo�sseofof/Inspection. � & ;,, ti 7 <br /> JLX�"ll i�L C7 l Q7 O 1 `w^,n o <br /> q � <br /> OWNER'S SIGNATURE <br /> �/�-� ,,,..�,,'''111 ��^ (date) F3 A <br /> ZONING ADMINISTRATOR <br /> -CITtri f- V37 11 <br /> o _o•o k1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED y <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEEj <br /> y: H <br /> H M O <br />