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m z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning AdminW ator g <br /> APPLICATION FOR LAND USE PERMITS - W <br /> _ q N � <br /> I r��d ,(I�l/ n C 3 � <br /> OWNER �l1)11(A. ,V1U! V (,)�J 6 <br /> TELEPHONE/.I l , l ('�I—(f 3�� (/U <br /> MAILING ADDRESS k-. 'o ( 0(1- �/) � -UgYA ST � � 'VU 7 <br /> PROPERTY ADDRESS 2��� C60A id A Wj n�k(' UJI g 1 <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 11 ADD ADDDYITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO❑ STAIRS ❑ FILLING/GRADING 0 CAMPING UNIT{al <br /> .COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ c � <br /> STRUCTURE/ADDLTION USE: c y� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (�N,� <br /> BUILDING CONTRACTOR: r) <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> N. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a ' <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, OQ p <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDINGS) $ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 S <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. C <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, 5. rn 91 h <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. .L <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE I� o 9) <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. L y Q) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. l 91 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G LT d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. e Z 8 U <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ur <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE_USED FOR HUMAN H ITATION. <br /> 7. ^ gga���naro <br /> I declare(fiat this application(Including any accompanying schedule)has been examined by me and to the hest of my 3 02 <br /> knowledge and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a m H- e: 'O - .•] <br /> a : <br /> Informsdon contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .^e E.> a m N yy <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a perrntt. I •< L' <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am provlding in thiso '� ;.,i,`!'n ro <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-descd is11es�alt any reasonable time/for the purpose of Inspection. <br /> OWNER'S SIGNATURE I`�° z(��� a A 'a O <br /> r��m � a ✓ k( a r) (date) " s n41 <br /> ZONING ADMINISTRATO ,..I <br /> io C wF. l*1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF SUANCF <br /> ��� -41,e� � (edtD -fck" Alvhjh <br />