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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a z <br /> APPLICATION FOR LAND USE PERMITS g: m <br /> OWNERm aoi, SCp�e.� ( TELEPHONE ° U� <br /> MAILING ADDRESS3D' � 7��✓nSU/�/e �K� � 03 � i ✓ VI l�-c 5.�3,��/ <br /> PROPERTY ADDRESS poUanSlc.L� i(l� <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION O DECK O GARAGE/ACCESSORY STRUCTURE rn <br /> BUNKHOUSE O 59.692(1V)GAZEBO O STAIRS O FILLING/GRADING O CAMPING UNIT O O <br /> COMMERCIAL BUILDING]j❑��1J ,,,,/COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE O <br /> STRUCTURE/ADDITION USE: _/r Gi.d' 7 !fJh 7LD <br /> Z <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> r1 <br /> Q <br /> O � � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARL4L OR TOP VIEW) r o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. G <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW In <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). y <br /> IMENSIONS IN <br /> T OF THE FOLLOWING: <br /> 3 TOOCENDTER INE OF ROAD,E(C) BUILDING MEASUREMENT(S)BUILDING(S) <br /> TO ALL LOT ORDINARYY HIGH EW TE)RBMARKING(S) <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. d "1 5ZN <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5. 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 �Ic <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. r 'W ' <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: �lU <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C> <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. h Q, <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. I I� <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GEO ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. rnVkShb2 7 lD�Worn SILt� lD� �rrL.2 F <br /> 7. <br /> Q � > a <br /> oi;o� � � <br /> xo <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of myy- e o � n a o y' 5'knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all re <br /> " �. 8 N P w <br /> information contained in this application(Including any accompanying schedule)and i further declare that I recognize that this r m en p- E " ' <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I n ?R c <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this m "in ss <br /> application. I agree to per <br /> county o% s charged with administrating county ordinances or other authorized <br /> access to the above-described pre Ises a y reasonable time for the purpose of Inspection. Person to have 8 o o <br /> 3 rt yggoSo 'i <br /> OWNER'S SIGNATURE - A a c <br /> � v a _: m � <br /> �I (date) o a 5 Q !=. <br /> ZONING ADMINISTRATOR '� " gA RM <br /> , <br /> y Sw : sni <br /> F,Ri <br /> TOWNSHIP PERMITS MAY BE REQUIRED C7` <br /> 22 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ` <br /> J N O H t�I, U� <br /> l�!-�1010-6d d c,p b tl 17�A,--k �S t6{ice/d� �'07�� � 0 0 0 8 8 <br />