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C n p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a d <br /> APPLICATION FOR LAND USE PERMITS N <br /> OWNER TELEPHONE a <br /> r4ev .-v a- M. reAA,a Sal-) ze (6611 - L137 - N93 e <br /> MAILING ADDRESS (� <br /> 3Frr� Na&iZberr � _eke <br /> � t. , I`nh 55033 <br /> PROPERTY ADDRESS (�I <br /> LEGA 44 CRI ION <br /> 4o Y 41 11 g1ecK i _Tti-C—� rtlzs <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING, ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING ❑ CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE 0 S f° <br /> STRUCTURE/ADDITION USE: e.v�t.. C C - <br /> 0 <br /> (Home/Cabin;;+Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: .____,S ._� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS <br /> WILL BE RETURNED. c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tn=r O (% <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d K <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW tv.1 as c <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N U Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK S' O cs <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O OO <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES 5. O <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. S v, I <br /> /Y INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. w y <br /> �V IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE c AJ <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 O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C, <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. In 7y S� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED `NATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. i� <br /> 6. <br /> 7. S o r) r) o O c 0 <br /> F 2 o rn . m o o` ' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 F) ,Z R R = e P w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all i <br /> information contained In this application(including any accompanying schedule)and I further declare that I recognize that this v D Dd to N <br /> information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <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 o `,N <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized erson to have '� n.2 0 0 : g o 1 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. m rPo 1 5 so3 v se w <br /> 3 m �, 9gg � oo 'i <br /> t ( <br /> am Eft <br /> OWNER'S SIGNATURE �►s e�1. ll r 11.�u m 5' 10-0 n yy y> o. W r� y n <br /> VVV (date) o, 5 <br /> ZONING ADMINISTRATOR � �O y K "111 ; <br /> � <br /> _. g s <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />