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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS a <br /> y <br /> OWNER TELEPHONE <br /> MAILING ADDRESS /a C_ of.. e <br /> PROPERTY ADDRESS (Y C� <br /> al-17 y Laff-oJf�e bdz.dr' <br /> LEGAL DESCRIPTION <br /> SeC r J _ <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION STAI S ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE1❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: SCC``e� I"/�/ <br /> z <br /> pp (HHIom\e//Cabin; Commercial Business; Bedroom; Deck; etc.) o 0 <br /> BUILDING CONTRACTOR: q 2 1l I CO 0 5�( ti C too r\ -7-H C. 7/S-ddo 1 7q <br /> P.o4oA �)3c, s" `rZv�_ k <br /> ER. S7} <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPANY INC MPLETE OR ILLEGIBLE PLOT P NS C <br /> WILL BE RETURNED. <br /> C o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 'tiy c <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 m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m "O <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDI G(S) i? <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK El <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. N w <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. °�° a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C7 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., HE i <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> I-� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE W EN — <br /> NEEDED. t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: '— M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' XI J <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. !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 C NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6• ^ py Dnw 090 'd <br /> ry A � 3 � iii ts1 <br /> 7. H m yg.T„ c <br /> 3'O dao <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my know) ge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Informatio i I <br /> q 6 M N <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 <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further ac[e tall 7 <br /> n`"o r' <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above c <br /> described premises at any reasonable time for the purpose of inspection. cm O <br /> OWNER'S SIGNATURE IIA L (date) j ay a <br /> 'R N F6U0 t� <br /> ZONING ADMINISTRATOR 1 rola <br /> c <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />