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— pZ' <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> MAILING ADDRESS 7 Z S � /��,)�nI ��y <br /> � 5- 1). l\ <br /> PROPERTY ADDRESS / R]4C"" �3'"'—tom '(3 [ 44-V� C <br /> LEGAL DESCRIPTION b 4- <br /> C�-y l�Iyt I <br /> llt---UUU ffl � -CJI 4✓I�I <br /> TYPE OF PERMIT($): SINGLE-FAMILY DWELLINqVDDMON C DECK GARAGE/ACCESSORY STRUCTURE❑ 0 <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO CI STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL <br /> ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commeraa Business; BedroJm; Deck;etc.) <br /> BUILDING CONTRACTOR: Dti N <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8 1/2LA <br /> t X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PNS <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r - <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW 6 c <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v '' <br /> AND INDICATE NORTH(N). p cam, z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK l . <br /> (OHWM)OF LAKE,STREAM OR RNER AND WETIAND AREAS,AND(D)LOT DIMENSIONS. <br /> 9. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(S)AND DRAINFIELD(DF),AND ALL DISTANCES Cp <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 1 <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1Ip`'1/1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: F <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. d iF <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p <br /> 9. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER j^1 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGEISTORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. , <br /> 6. <br /> 7. <br /> F > 6 ' 3 - " 2 <br /> Ideclare <br /> wledgethat <br /> nd belieitisttrueon,correct g any <br /> ej has tI am been responsible <br /> for <br /> thedned by me and taMe beat ilandaofmy 0 ,2 „ <br /> information <br /> andbelie/IiIstrue,wrratiantl compleany te. acknowledge Nateul )andI fart for MearethtIeconq of Oat <br /> _ - - <br /> informationIampretlingwillherelieduon(includingoMecunty of Burnet Wisconsin in <br /> lterminher ng wiseter issueaeMat[M1is � = > cg m , <br /> intmation I am providing will be relied upon by Ne Caunry of Burnett Wisconsin in determining wM1e[M1er N issue a permit t a °' -- <br /> furthera�ptallliabilitytWtmaybearesul atneeounry of Burnett relying on this information I am Providing In this T5 , - til <br /> application. I agree to Permit county om'' zchlfrgetl wiM administrating county ordinances or all aut oriaed sonM H R8 <br /> have access to[M1e above-tleuribetl ses CCC Tea na�etime fortbe purpose o/inspeRionfor Me purpose o/inspeRion. _ a > Nw v ? <br /> OWNER'S SIGNATURE <br /> (date) i <br /> ZONING ADMINISTRATOR <br /> c � ? <br /> TOWNSHIP PERMITS MAY BE REQUIRED - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS@AW TETT COUNTY <br /> ZONING U U <br /> ty <br /> o <br />