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vI Z <br /> o <br /> a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3: <br /> APPLICATION FOR LAND USE PERMITS 0 <br /> OWNER V � �v. ( y TELEPHONE <br /> MAILING ADDRESS 11 /' vV C/ ,�--\� n F <br /> PROPERTY ADDRESS/1 lu 0 1 <br /> LEGAL DESCRIPTION ju I� ( vISUn� N�.I yy Sed— b , �� c�y o_ <br /> TYPE OFPERMIT(S): SINGLE-FAMILY(DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 ?. <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS 0 FILLING/GRADING 0 CAMPING UNIT❑ <br /> m � <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ �CIOMMERCIAL ACCESSORY STRUCTURE❑ �1ry, <br /> STRUCTURE/ADDITION USE: U I ul "1 Q l C 3�/YA U I W°j^ 4 <br /> (Home/Cabin;Commercial Business; Be oom; Deck; a .) <br /> BUILDING CONTRACTOR: Se) <br /> O <br /> 77 c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 <br /> WILL BE RETURNED. a <br /> f'1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C O <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 n <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J c <br /> AND INDICATE NORTH(N). G 8 Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDINGS) UJ 5' o <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <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 <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. J__ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 HCl Y✓ o <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. I� r <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: N �` J <br /> z (n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. � H � G <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. y <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER IC's <br /> SETBACK AREA. O SIO <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> /. s7y > nooaoro <br /> ° n � 33356 � 77 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0,� <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all �, ' py != E_ EL P .3 <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this m E. am ti a <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m ? a w'= ..d <br /> further accept all liability that maybe a result of the County of Burnett relying on this information I am providing in this 'tea q, d,` N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to n n m o : g o <br /> have access to the above-desc' premises at any�lpona,#time for the S urpose of inspection. > .4 s.4 N <br /> o t! > <br /> OWNER'S SIGNATURE I� m a g <br /> (date) n c a? <br /> ZONING ADMINISTRATOR c <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g . <br /> S O o 0 0 <br />