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C o <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> OWNER y/� L,�-. / TELEPHONE a <br /> MAILING ADDRESS r .^. <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION S <br /> TYPE OF PERKrr(S): SINGLE-FAMILY DWELLING 0 ADDITION DECK 0 GARAGE/ACCESSORY STRUCTURE❑ II1T` U� <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 I ,� <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 0 a <br /> STRUCTURE/ADDITION USE: O/'�� �'• ? V <br /> (Hon <br /> )q�/Cabin;itamnercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> -115'CA5-090 / 41 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 his X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS p R <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C I 2 <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 NEWo <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Q <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) O o 6 <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK %L I ) <br /> 4. SHOW(OHWTHE LOCATION OF LAKE,STREAM <br /> FMOR THE WELL(W),SEPR AND TIC TANK(S(ST) DRAINAND O ELD(DF),AND ALL DISTANCES G <br /> TO BUILDINGS,ROADS,LAKE, LOT LINES. <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 (P- <br /> PLANS <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. -C 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> 17115 PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> UQ1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. I L 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O a <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 d <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITA7{I.,ON. ® <br /> 6. �.01d1;CMCNILUP (,dJr IJ�a� r nelCettX <br /> 7 Membetj- N® Arkfif10"�sC 4(iLg A44a, <br /> ( x Ba <br /> chg a3 <br /> I declare that this application(Including any accompanying schedule)has been emst d .'2nlned by me and to the bemy 3 ? e <br /> knowledge and begat it Is true,correct and complete. I acknowledge that I am responsible for the detail and aaurm of ell TL o m e. b,: �) <br /> Information contained In this app&ation(YhdudtW any aommpahrykhg )and I Tunher declare that I recognize that tis v �.a a m n y <br /> Infonnatlon 1 am prowling will be repeat upon by the Comhty d Burnet Wtsccrhskh In datemYnln9 whether m Isehte a permlt. t m 5 $. S N ro <br /> further accept all liability that may be a result d the County d Burnet relying on this Information I am providing In this 9 .1c: t' <br /> application. I agree to permit county dRdals charged with administrating county ordinances or other authorized person to have Q aro 8 W n <br /> access to the above prem at any reasonable time for the purpose d inspection. =� /�/ g 8 g 8 y <br /> bfnNwmo <br /> OWNER'S SIGNATU c H , B =2 <br /> ( ) 5§ ran� <br /> ZONING ADMINISTRATOR a e S a m <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COU <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING <br /> N N O O O O <br />