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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS : w <br /> y <br /> � A <br /> OWNER I \ N I .I/ U (C ) , / TELEPHONE / �/•-a��-_6 �6�' <br /> MAILING ADDRESS 50Ca8/ &J— <br /> PROPERTY <br /> PROPERTY ADDRESS ,a7d c)!J Lds� l-U�C0V�C/ J �q"` _ "v C'-V .� <br /> 1 0 R) <br /> LEGAL DESCRIPTIONG,L,3 Sec 6 '/y S ? N , K l6 k1, G, L, s, Sec. 3f, T'Yok� R bu) <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE ADDITION 0 STAIRS <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 ^ <br /> /� o <br /> STRUCTURE/ADDITION USE: ql ¢ 1!-o g F 6n ONC Sf�X 01- <br /> (Home/Cabin; <br /> '(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ^� �( <br /> BUILDING CONTRACTOR: C' J/n. F0 SS 0/J O N C (f-I I <br /> y J <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS A O Q. <br /> WILL BE RETURNED. <br /> � Cr <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnf <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> w <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, „ s 3 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) N o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Gd .o <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. w' N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES ty i <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 3j <br /> o <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �' w i1J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 7o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <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: <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. n Q OI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. B z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 'p W <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. <br /> N6. AqT//TOB USED FOR HUMAN HAB TION. gr <br /> ,,[. p // '� C <br /> YA' <br /> 7. U es�km E C <br /> � am R > ob <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge ? ee tsf <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information h r' ^ it 7? <br /> contained In this application including an accompanyingschedule and I further declare that I 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- <br /> described premises at any rea a time for the p rpose of Inspection. <br /> 8v or <br /> OWNER'S SIGNATURE L/�a tl <br /> 2y n 6 0 <br /> � n SZ 4 . <br /> ZONING ADMINISTRATO Y Z <br /> _.. M <br /> TOWNSHIP PERMITS MAY BE REQUIRED S g w <br /> THI ERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />