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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator & 2 <br /> APPLICATION FOR LAND USE PERMITS s <br /> a <br /> OWNER y <br /> 1 '� PL(C�"l TELEPHONE <br /> MAILING ADDRESS <br /> 70 car M 55079 <br /> PROPERTY ADDRESS � <br /> a p <br /> 5 l lr rr r/ilru -Rd SQ eo, )er W1 � o <br /> LEGAL DESCRIPTION (� <br /> J <br /> o00 . 6yjD %owrish <br /> of Rcln P5� <br /> TYPE OF PERMIT(S): I� <br /> SINGLE FAMILY DWELLING❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ RS ❑ {���rnef} <br /> FILLING/GRADING 0 CAMPING UNIT❑ BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ DECK 13VVZ O <br /> STRUCTURE/ADDITION USE:_ (2X0r(kc <br /> (Hoiire/ n; mme al Busine • room; Deck;etc.) z <br /> BUILDING CONTRACTOR: <br /> ti <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O n <br /> WILL BE RETURNED. <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 q °: <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, ro ^, c <br /> AND INDICATE NORTH(N), o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) w <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK J '� <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES O <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 7 <br /> NEEDED. O <br /> rI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (,) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 Z <br /> SETBACK AREA. <br /> S. 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 /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge c h1 m S7 a C ov <br /> and belief it Is true,correct and complete. I acknowledge t I am responsible for the detail and accuracy of all Information �° Pd R En <br /> contained in this application(including any accompanying hedula) d I further declare that I recognize that this Information I x b <br /> am providing will be relied upon by the only of Bu ett isconsin I mining whether to Issue a perm[. I further accept all <br /> (lability that may be a result of Me Coun of Bumatt Iyi on this In r on I am providing in this application. I spree to perm[ w H <br /> county officials charged with administre ng county o na ces or*the u rized person to have access to the above <br /> -dasalbed <br /> promises a[any reasonable time for Ma urposo of ins on. <br /> Iff pH�M pNr <br /> NK IN ft <br /> ry V O ANO l <br /> OWNER'S SIGNATOR 1 I <br /> G (date) Kyo C)N u, M Y <br /> �j Icy <br /> ZONING ADMINISTRATOR �/I �( rA <br /> z <br /> TOWNSHIP PERMIT MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR <br /> FROM DATE F ISSUANCE <br /> #�wm�+ 4 tz4 piGred upj C�er� lcpsieih <br /> p H <br /> H O H U O <br />