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C A p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator � a, <br /> APPLICATION FOR LAND USE PERMITS �: y <br /> OWNER 2I aW9L6 I�of�IOTT TELEPHONE <br /> tOJ m <br /> MAILING ADDRESS <br /> �93W HI TH A0E 1 LAhrii Y)A, S E 41 1 <br /> PROPERTY ADDRESS (� \ <br /> LEGAL DESCRIPTION OF 'l i LJ S E <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK O GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r"' <br /> 0 <br /> STRUCTURE/ADDITION USE: STORA F c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: R A m �V h L O l r S INC 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. 0 <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (ES)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Q `. v <br /> AND INDICATE NORTH (N). z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ? <br /> O o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Sb <br /> \ <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES D:-� S. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. p v, <br /> 5. 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. I y <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ,..h <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z <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. �. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. G <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Cj <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. � g3a 0onc <br /> I declare that this application(including an accompanyingschedule has been examined Z 0 $ ? w r <br /> Ppl ( g Y ) by me and to the best of my g o ,2 �. ^. _. e . <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detall and accuracy of all <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I 4! <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this 00 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to haveO,°0 o S o <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. E; d,.n n <br /> �7 <br /> 9cgacoy <br /> OWNER'S SIGNATU B'`"es' 1} mc o d cc <br /> E i n ._ <br /> ZONING ADMINISTRATOR Ian• 0 6 <br /> 2 � a � <br /> TOWNSHIP PERMITS MAY BE REQUIRED RR��� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA77YPNETr COU <br /> ZONING <br /> S000S <br />