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c � Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS : (j) <br /> e <br /> OWNER TELEPHONE <br /> S- giISA <br /> V <br /> A <br /> MAILING ADDRESS <br /> I' '�-'Lam. i-• 1 rt <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION �.{._ CSM V i 10j� � (��C 5g / _ _ L` <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION ❑ DECK ❑ GARAAGGE/ACC•CUEJSSSORRY SSTRUCTURE CI �" , g <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT �_�•1 <br /> 0 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r" <br /> n 0 <br /> \ c <br /> STRUCTURE/ADDITION USE: - f- J } o <br /> (Home/Cabin; Commercial Business; Bedroom;'Deck; etc.) <br /> BUILDING CONTRACTOR: n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh 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) <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p R <br /> AND INDICATE NORTH (N). �I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) i0 ° <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. I O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES _U R I <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w <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 o <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 �) y <br /> NEEDED. /Wry-C <br /> THIS PERMIT IS SUB1ECi 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. `( <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 Q �} <br /> SETBACK AREA. /` I <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. c� <br /> 7. 9 o no n � <br /> 3 a <br /> F x 8 0 3 ^ o o�. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my o 1 2 R R i P w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all m !w•F_E: <br /> Information contained In this application(including any accompanying schedule)and I further declare that 1 recognize that this <br /> 6A 66=: <br /> Information I am providing will be rolled upon by the County of Runoff Wisconsin In determining whether to Issue a permit. I @ 5 w _ w v. <br /> further accept all liability that may be a result of the County of Bumett relying on this information I am providing In this w »»: LAN 'd <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have o g: $$ tr <br /> access; <br /> to the above-described pre any reasonable tlm for the purpose of Inspection. mE o o w N 8 8 y <br /> d ,'r7s n o 00 0 .yi <br /> OWNER'S SIGNATUR /_/Z <br /> �- (date) <br /> ZONING ADMINISTRATOR � ) m i 1 w°°0 ° <br /> p L6 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS E N <br /> JAN 23 2012 <br /> BURNETT COUNTY <br /> ZONING <br />