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q z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator s <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER TELEPHONE <br /> Wm�k.,gnn a-./I i-m.1ea9 c.�InrlYl ioSm- K3l-�/ br> 3g <br /> MAILING ADDRESS i l CI l O 3-6,A 4 <br /> AuY 1 AST i-ALS <br /> PROPERTY ADDRESS <br /> Zl `) I SAe40 LAK— IZO tj LZSTtr w— <br /> LEGAL DESCRIPTION �„r 1 <br /> TYPE OF PERMR(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ g <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> v <br /> COMMERCIAL BUILDING 0 COMMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: GA131.4 1920122"109")( 7-54) -L,� .J Fn1 n <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.)(,Ul/Q'x ag'Wff/fvD. <br /> BUILDING CONTRACTOR: —L <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ih X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C c <br /> WILL BE RETURNED. 5 <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. m �, <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW re w <br /> BUILDINGSISTRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, �y <br /> AND INDICATE NORTH (N). z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) $ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w <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 G <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. R <br /> S. 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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. ` 1 <br /> U} <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I x <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. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Ri <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> a' <br /> I declare that this application(kldrding any a000mparrylrg schedule)has been e:artmlrhed by me and to the beet of my g <br /> knowledge and belkf it is true,coned and complete I acluhowleage alar I am responsible for the detall ad&=racy of all n to wy G �a <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I reoogntra that thisIntionnaklo <br /> fu accept all liability't�messy be rallied upon <br /> ooff the County W Burnettarelying ct Wisconsin <br /> bdlarna�tlar Imam whether <br /> rntlUg In thIssue a is 1 e& "°= "rod <br /> application. I agree m permit county officials charged with administrating county onlInances or other auNwteed person to have 6 .� 8 t. <br /> axe's to the above-desvlbed pranWes at ary reasonable time for the purpose of Inspection. rp <br /> OWNER'S SIGNATURE 3 (da/M) to � d t o <br /> � ' <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED a aro <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U U 8 0 0 o S <br />