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y ro c <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS o c <br /> OWNER ^ n y CT ./ TELEPHONE 3 i5 3S-Y'� S a <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS Act, <br /> LEGAL DESCRIPTION r, <br /> TYPE OF PERMIr(5): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/ DING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRU RE ❑ <br /> STRUCTURE/ADDITION USE: i + 2.' (��tf �' c z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; et . <br /> BUILDING CONTRACTOR: W <br /> n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN a+h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR 70P VIEW) n <br /> m <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, e <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) o o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ' <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. (�D <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 5 "I <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. A rn <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. R) <br /> J <br /> NOTE: NG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN Cri <br /> NEEDS y <br /> NEEDED. (, I <br /> O p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <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. -J <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 O <br /> SETBACK AREA. .� <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. Mbt, + rmplemm4- bu,-F(e.r ' e �pradio�� mer✓ced�ar��OCa� c� outline,( � <br /> 7. bkl 4LiL Lav`d a-Wa {e✓ Cor 5�✓✓Gt�zen f � <br /> aa ro <br /> I detlare that this application(including any accompanying schedule)hes been ehmmined by me and to the best of my 3 0,°Z <br /> knowledge and belief R Is true,correct and complete. I aclmowledge that I em 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 thisa m^ <br /> Information I am provldbhg will be relied upon by the County of Burnett Wisconsin In determining whether to ham a permit. I a n > <br /> further accept all liability that may be a result of the Cqunty of Sumett relying on this Information I am providing In this <br /> application. I agree to permit county officials chargedpft administrating county ordinances or other authorized person to have <br /> access to the above-described M any 7ble time for the purpose of Inspection. W 5 ,N <br /> yogoSo <br /> OWNER'S SIGNATURE S( a A a a tt v, ,� C <br /> ZONING ADMINISTRATOR � <br /> 2 '5 M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> 1e4ki �a�ed >o 6-av7.1 Gam <br />