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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 A c <br /> APPLICATION FOR LAND USE PERMITS a <br /> I <br /> OWNER TELEPHONE 7 <br /> , p/G 4_ q/�D O <br /> qi <br /> MAILING ADDRESS 74;;7 /Y� <br /> Q.)l E^ <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION y <br /> 5 <br /> SINGLE FAMILY DWELLING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 5[ STA RS ❑ o <br /> TYPE OF PERMIT(S): ,a <br /> FILLING/GRADING ❑ CAMP-I�NG UNI�Ti❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK74 <br /> �4 <br /> STRUCTURE/ADDITION USE: .% Irl z <br /> �(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: YVI /Y^ i (`/ h /�IJ 64 J�J 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT LANS <br /> n J <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARULL OR TOP VIEW) o_ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C• t7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW C I R <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, 'd <br /> AND INDICATE NORTH (N). I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDIING(S) c <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARKT 93 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. I N w <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DIST/yNCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. a°o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C7 c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,ITHE g. 0 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN <br /> NEEDED. rO <br /> Q � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. I � <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. pJ, <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. :E <br /> 6. <br /> s ty �nm �7a ro <br /> 7. R' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge xw y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and acaracy of all Information e <br /> contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this Information I <br /> am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all <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 /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above S [f n <br /> described premises at any reasonable time for the purpose of inspection. 5 CIT <br /> OWNER'S SIGNATURE W(3�[A'H:F/�/ ���2'd / e A S o, z <br /> (date) y S� <br /> ZONING ADMINISTRATOR r ' ' `a�' <br /> ( ) <br /> TOWNSHIP PERMITS MAY BE REQUIRED C' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> l�e�✓}-til� -+- 1�l'�e/ �'hQ�I eG� �v �I,oa✓dL. (,��h�'� - as -c�� <br />