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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administratoru 9 z <br /> APPLICATION FOR LAND USE PERMITS Z <br /> N N <br /> � C <br /> OWNER TELEPHONE vl <br /> MAILING ADDRESS / as i 0 <br /> PROPERTY ADDRESSa <br /> �� �,`3 S ^j//G�ii/ /)•• _. / Gl/Z l <br /> / <br /> LEGAL DESCRIPTION <br /> DWELLING/BUILDING ❑ RAGE/ACCESSORY STRUCTURE❑ ADDITION)lk STAIRS ❑ <br /> TYPE OF PERMIT(S): 'O <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE 1159.692(1V)GAZEBO ❑ DECK o <br /> STRUCTURE/ADDITION USE: ��-Gi;,/ hFdu H� r o S <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 4 <br /> � V <br /> BUILDING CONTRACTOR: AY2 42/1/ --" <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 3 + <br /> WILL BE RETURNED. C o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o, ? <br /> n <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 s .`.y <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Og <br /> AND INDICATE NORTH (N). ` n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0o 11 3 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK }+ v <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. c w I Z <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. °O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. CT1 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. o' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f7 F J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. el <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER I J Op <br /> SETBACK AREA. C <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. ^ng yy >r E G> <br /> 7. <br /> w n wa,rc Rw g= <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge 9. z ,,, ^ :3 <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o r <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all g N N g <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 m <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- v, <br /> described premises at any reasonable time for the purpo of inspection. Fd �!° c _y <br /> •zI : zz <br /> 5 r <br /> OWNER'S SIGNATURE J44 <br /> S w > 1 Z <br /> ZONING ADMINISTRAT <br /> TOWNSHIP PERMITS AY BE REQU <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE 5MAIERTC6OUNTY �U <br /> tmi �' d I � ►� �7e�' i � Jo�PhZ� Goon t1-x -06 <br />