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C Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS y y <br /> o <br /> OWNER /7 J TELEPHONE r^ <br /> / ° <br /> /( Pt' �J�". 3Y9- SWV1 o <br /> U <br /> _ / / <br /> MAILING ADDRESS Z jj ���/ S/1 /4.7''c/ ; `/-{/�.�2. S/GJ i4- KiZ- <br /> tt , <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> ���� C) i <br /> TYPE OF PERMIr(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DE K 0 GARAGE/ACCESSORY STRUCTURE m <br /> 0 4 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE 0 c <br /> STRUCTURE/ADDITION USE: G,g ✓/-��� �" 'Z� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ° $ <br /> tN <br /> BUILDING CONTRACTOR: W <br /> J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> a <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. C <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, l <br /> AND INDICATE NORTH (N). N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS) TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK �' p <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 t <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. .. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE �I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. Y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r. <br /> � 5 i <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. y <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. I CP <br /> O t� <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. p �� <br /> I <br /> 7. ^�z o 0 r o n c 0 '9 <br /> trI <br /> PP (including Yaccompanying ) Y y � omm ,v000 <br /> I declare that this application Indudln an schedule has been examined b me and to the best of m B e ,� � � ? w 3 <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ally m, <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this =_. 9D m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I a no a 'c= 'V <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this it ;n d,-.<' =n 'V <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. o"w'„�+, c o <br /> > <br /> 000000 <br /> 9 <br /> OWNER'S SIGNATURE <br /> m n <br /> '(date) o g m <br /> ZONING ADMINISTRATOR_ [ �{� �C G�Gt/'1 '� w a�n tin <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> � U00000 <br />