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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator R Z <br /> APPLICATION FOR LAND USE PERMITS <br /> e <br /> OWNER /Ih��� /S0� TELEPHONE17 <br /> MAILING ADDRESS m6V ,,g t' 7 ,.$ e / OD S c� p "ti0 <br /> ii <br /> PROPERTY ADDRESS <br /> O <br /> LEGAL DESCRIPTION c 'J <br /> SINGLE FAMILY DWELLING ❑ GARA E/ACCESSORY STRUCTURED ADDITION D S AIRS Do <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING O CAMPING UNrtX BUNKHOUSE D 59.692(1V)GAZEBO O D CK O _ <br /> STRUCTURE/ADDITION USE: mra hness; Bedr om; Deck; etc.)(Home/Cabin; Comm Z 4 <br /> e <br /> BUILDING CONTRACTOR: I Qj <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEEPOF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS m H <br /> WILL BE RETURNED. ; <br /> T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) — � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. lf'I I O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW n <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 6 <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) I Rl n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAP K 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTICITANK (ST)AND DRAINFIELD(DF),AND ALL DIS ANCES w o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. MO _ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. _ CJl Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCIhITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE — <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 WHEN �� \ I <br /> NEEDED. rW r v w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUI EMENTS WITHIN 60 DAYS OF PERMIT. f°'r. Z <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. 8 I^ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. (� <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Cr <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> — A >nm^> o� <br /> 7. <br /> 7 <br /> '-S 0Q. <br /> 33x °mc a3 Q. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It is true,correct and complete. 1 acknowledge that I a responsible for the detail and accuracyof all informati0 Ir <br /> contained in this application(including any accompanying schedulej and I further declare that I recognize that this information I o k > <br /> am providing will be relied upon by the County of Burnett Wisconsl 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 m <br /> permit county officials charged with administrating county ordinances or other authorized person m have access to the above- o c f] <br /> described premises at any reasonable t e for the purpose of insp ion. 9O= s = y <br /> 3 u o > <br /> m <br /> OWNER'S SIGNATURE ��"�� / �PJ a e S &0Z <br /> ZONING ADMINISTRATOR : <br /> CA: w <br /> + aBf <br /> TOWNSHIP PERMITS MAY BE REQUIRED w »N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE M €�N <br /> ICkya Gt/e� by -71-2Ori C���sfe�he�svh � 7 <br />