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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ti z <br /> APPLICATION FOR LAND USE PERMITS g <br /> N y <br /> OWNE /'715\Z='-I 79 <br /> J <br /> TELEPHONE l J 3 <br /> 1 <br /> MAILING ADDRESS <br /> S S I-I o <br /> PROPERTY ADDRESS <br /> i t 5l n b I C'i <br /> LEGAL DESCRIPTION 830 c <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE O ADDITION 0 ST RS 0 0 <br /> TYPE OF PERMIT(S): re <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 <br /> STRUCTURE/ADDITION USE: t rz <br /> (Home abm; Commercial siness; Bedroom; <br /> BUILDING CONTRACTOR: I,A. <br /> J � <br /> (� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X31 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLO PLANS � rnii <br /> WILL BE RETURNED. O -K <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O o <br /> � � 6 <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 y (� <br /> BUILDINGSISTRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m w <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUIL ING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAP K 1 R <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. c wz <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DIS ANCES ' � ? <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ET .,THE 00 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE NHEN r -�- <br /> NEEDED. "1� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G <br /> Z <br /> a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r, 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4, NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE <br /> SETBACK AREA. Q <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGF/STORAGI ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> Or1S�k CC 7o aim a ro <br /> 7. Fns Ila <br /> 9 w c w <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my kno "y e n <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Informati <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this informa on I ^ Y <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further aa ept 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 o <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the abo e- <br /> described premises at any reasonable time for the purpose of Inspection. pp = y <br /> OWNER'S SIGNATURE --��q(�f � _ -P-P®Y( Q� /y tP O <br /> U v (date) Q w 0 9 Y7 <br /> ZONING ADMINISTRATOR f�� �L n.I a ^.'o` $? tMs7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` <br /> y: N: <br /> W y N N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O� 8 <br /> P�im� f I�f�cr �c�lCd tb Pei'y YPenheimz <br />