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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: <br /> y <br /> d � <br /> OWNER � n n C TELEPHONE -5 <br /> Q .— /Q fe n e n <br /> IL 4—L ` , ZJ T 7 � <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION r � <br /> Lo-t I (,ern ✓o/ 13 Lk 93 rr Ge.,L�T ►, 7f <br /> TYPE OF PERMIT(5): SINGLE-FAMILY DWELLI G ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE g TT <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ �V <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial B ess; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: �� S• <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 eh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. y � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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, 0. a <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) O <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 90 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. l7 G (r! <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD(DF),AND ALL DISTANCES A0 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <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 y <br /> NEEDED. <br /> C? <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. O n z <br /> p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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 p <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. tJ <br /> NOT TO BE USED FOR HUMANHABITATION. <br /> e� <br /> 6. YLkf+ re MLL_S t be 2 30' 'Flro✓Ij roadrtbk, Allath-'- 0 <br /> 7, fhfnum6"k' s�21zI(a�c(aV- baCks 0 -/0' s > n c acro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my B 0 9 8 $ P w' <br /> knowledge and belief K is true,correct and complete. I admowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this =.> > to <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this Q 5 X <br /> aPPllration. I agree W Permit dols charged with administrating county ordinances or other authorized person to have ^ �.2 S 0 S o H,y <br /> access to the abovrdesezt remise <br /> at <br /> able time for the purpose of Inspection. to C d o c c <br /> E > o 0 0 0 o y <br /> OWNER'S SIGNATU /,� <br /> Al 1 1 �l a / oUn (date) <br /> ZONING ADMINISTRATOR \ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N ti o s <br /> er mat Ce d Pe P� P-) <br /> .0r..,rp.e( ti <br /> 2 U 1 .t, ter#_ g� :. i C w Z <br /> �pX <br /> \ Lmdlka <br /> Oman <br /> i a <br /> 1p Him <br /> jama�ple,v,l9t <br /> 1 e 4Ig,yaenaiPra <br /> thancaoas89 <br /> mss, _ <br />