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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ° <br /> . Z UJ <br /> APPLICATION FOR LAND USE PERMITS y <br /> a <br /> OWNER �..;,e ii.J �/YIfL,f�RLy�� TELEPHONE <br /> O <br /> MAILING ADDRESS y, // �F� �f)�Ir) C M� 6a3I/3- �i i/ �} <br /> PROPERTY ADDRESS U �L (fF/ J' // I `j `7 / n <br /> LEGAL DESCRIPTIONLer 61 <br /> ? 'j <br /> i Q <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION Cl DECK 0 GARAGE/ACCESSORY STRUCTURE 0 S_ <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT ❑ G <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ � Z <br /> STRUCTURE/ADDITION USE: OCC (1dr 45-tF p <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: JQ n <br /> _N` <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C c <br /> WILL BE RETURNED. <br /> A <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) rnn <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 m 'O <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Elo <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) °� r <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK '� J <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O p n <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Ql i <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. „� w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d GI Q) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. (n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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. (T- <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p <br /> NOT TO BE USED FOR HUMAN HABITATION. C <br /> 6. <br /> Z s77 > nnno > O �v <br /> F m ry m o 0 5 � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my g o,°2 g R 8 e ? w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m d d a a <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this o g.> > m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I -, P w <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this c 5 a =w-S <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 pp ises atany reasonable time for the purpose of inspection. <br /> g 'i7 v > � oo � � "] <br /> OWNER'S SIGNATURF---" i $ 8 o > <br /> (date) o ` o = z <br /> n' B <br /> �1 ' <br /> ZONING ADMINISTRATOR y ' ` w S n <br /> m <br /> TOWNSHIPP MITS MAY BE REQUIRED <br /> THIS P MIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />