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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g P <br /> APPLICATION FOR LAND USE PERMITS z cr <br /> 01 <br /> OWNER / TELEPHONE .17 a 27 v1 <br /> MAILING ADDRESS g v <br /> PROPERTY ADDRESS n — <br /> hh�./// y Z o <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE .. w <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> v <br /> COMMERCIAL BUILDING ❑ COMMERCIApL AD/PITION ❑ COMMERCIAL ACCESSORY <br /> A <br /> ACCESSORY STRUCTURE ❑ <br /> i/t <br /> SIT) l�TU I (d/,' <br /> STRUCTURE/ADDITION USE: �FC o <br /> (Home/Cabin; Com rcial usiness; Bed om; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 '/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r- d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW tme w "' <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). Nz <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 wIs <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES r� <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5' m W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I� , <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE o VU <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. rrUj' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN i W <br /> NEEDED. C <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- <br /> 1. <br /> -1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z I s 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F l/nV <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER y C Y <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. <br /> 7. ^ yy > Yo '7 <br /> r A 3 3 3 u <br /> 8 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my3 0� � � � ? w' <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all c. m m p1 a 'y <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this D9 m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .� g c b <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premise i sonable ti purpose of Inspection. ti <br /> ��/�d�/�jrt�E <br /> OWNER'S SIGNATURE!/ � C.� ✓ �� ' <br /> „ a -: <br /> �I M [� �y �7 (date) � a ° x9 0. A � <br /> ZONING ADMINISTRATOR JI I I 11 �tel. q i-Qain �a, N 0 _ 6 6 <br /> O: s <br /> TOWNSHIP PERMITS MAY BE REQUIRED n C' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FTM DATE OF ISSUANCE <br /> � U000 � o <br /> �✓✓h�� � I�-{�-�e,�� I c 1cPd u ���� Yy'1 Cna'2'l7a ry lar 016-8 � �- <br />