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b Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS w <br /> OWNER i V_L► ATE�S / PAm ONE ( l0 ITif <br /> d <br /> O <br /> MAILING ADDRESS 1 0 <br /> V �V IV <br /> PROPERTY ADDRESSW. 0'W. r O C O <br /> LEGAL DESCRIPTION J ^ r <br /> R'\v4r U� AN T r o I` <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE m <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 ✓1 4 <br /> a_ <br /> (� <br /> STRUCTURE/ADDITION USE: �/y�r 't o <br /> (Home/Ca (n; CommercialBusiness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: _GordO f7 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vt X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m 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 'O B <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, CS v <br /> AND INDICATE NORTH (N). N 'z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O c" <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. G91 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES 1 <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 U; <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 <br /> NEEDED. <br /> \ L7 <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 0 <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. (r <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. 2 <br /> 7. "A 9 0 0 o n c b <br /> 'o' <br /> I declare that this application -. <br /> on(Including any accompanying schedule)has been examined by me and to the best of my a ,off P R p oe ? w° <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 <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this .o E. 9 9 <br /> Information t 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 reW9 g on this information I am providing in this <br /> application. I agree to permit co officials charged with ad nistre8 unty ordinances or other authorized person to have '° n o c, $ o ti <br /> access to the above-descnb re ises at any able ti of Inspection. E' <br /> OWNER'S SIGNATU CGQ/�-CC2/ 1° o' '' <br /> I - (date) o <br /> a.wro � � o �y <br /> ZONING ADMINISTRATOR I rr� ar) y °8 'c w ti E n ts7 <br /> 7 . <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ^N <br /> 1 e+ e ol-M4 ted tD &�` c, Wa+eis t 60rdd7 �kl�a � s <br /> 9-isab <br />