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b Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS o y <br /> OWNERVeTELEPHONE <br /> N,� 4Ne 661 / l6q`6lp7S <br /> MAILING <br /> ADDRESS q s-1— Tem,j bwy G.- f-r /V, N`Fdtf 6.-..-! )Av S S 37) i VI a <br /> PROPERTY ADDRESS f(3."! AGkV w,✓ 4,- J Fr[t urd L , �✓T_ 5 e i �3 l <br /> 1 <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS FILLING/GRADING El CAMPING UNIT ElIJL, <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o a <br /> STRUCTURE/ADDITION USE: (f W +C U c <br /> (Home/Cabin; Commirklal 1Bu nes(; Bedroom; Dec • etc.) <br /> BUILDING CONTRACTOR: 7 '.5-o a(1ti-d <br /> n <br /> r C4/ +"C Sr .0j Y. ,r• 1I S50 17 (c S) 330 Y783 9,4- Ahc(wsk, c <br /> A PLOT PLAN MUST BE PROVIDED ON AN rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G o <br /> WILL BE RETURNED. <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. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW h7 w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Q' •o <br /> AND INDICATE NORTH (N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) C7 d <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. q 4 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST) AND DRAINFIELD (DF),AND ALL DISTANCES <br /> S. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. C/.1 ti <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 00. <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. Lr- r ,� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN � <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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. Q <br /> 5. ACCESSORY STRUCTURE/GAR/AJ,-IGE PE/!RRMIITS ALLOW FOR <br /> /PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. NOTeTOeBE US7I &1�I/ <d� /' <br /> 7. .S <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to0 the best of my g o ,7 ' <br /> knowledge and belief R Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all m B. ... _it ; y <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this E. 9 Y to ; <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .� ,��, a ,Z j > <br /> further accept all liability thW7numett relying on this information I am providing in this : <br /> application. I agree to pe nlstratlng county ordinances or other authorized person to have m O �" 8 8ggaccess to the above-d r the purpose of Inspection. d Y 8 8 i-w y <br /> d o ^$ g <br /> OWNER'S SIGNATUR /� � o' co n y m O <br /> ZONING ADMINISTRATOR <br /> 0; <br /> TOWNSHIP <br /> o^ � <br /> TOWNSHIP PERMITS MAY BE REQUIRED JUN 6 2U12 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IIN <br /> u u g o 0 o g <br /> BURNETT COUNTY <br /> ZONING <br />