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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> _. <br /> APPLICATION FOR LAND USE PERMITS <br /> 4- <br /> c N <br /> OWNERJoel TELEPHONE _ 0 <br /> MAILING ADDRESS )o O V Fv-e Al v-( C. �J_ rfZ3.5 L4 /7 <br /> l� 10 <br /> PROPERTY ADDRESS `--� <br /> LEGAL DESCRIPTION r <br /> o — <br /> TYPE OFPERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ v� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT 0 ,5 <br /> COMMERCIAL BUILDING 0CA <br /> COMMERlZIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: ' 1 Z <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: n OOG <br /> n 4, <br /> o � L(>J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'fi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o �1 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) in., c <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o J O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <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 /> 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 o <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. c Cj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -C (n• (p/� <br /> ul 6 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Stl U <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. J <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. p <br /> 6. f C <br /> 7. ^ 'A7annnnaob <br /> gq � oOoBaftm <br /> n a 3 3 3 c <br /> n <br /> I declare that this applicatlon(Including any accompanying schedule)has been examined by me and to the best of my g o,°a <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 F r <br /> Information contained in this application(Including any accompanying schedule)and I further decJare 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. Id a Un <br /> b <br /> further accept all liability Mat may be a result of the County of Burnett relying on this information I am providing in thisapplication. I agree to permit county officials charged with administrating county ordinances or other authorized person to haveaccess to Me above-described premises at any reasonable time for the purpose of inspection. o oR n <br /> N df W <br /> m w d O O 0 0 <br /> c1��� - a(o - l l q > > O o <br /> OWNER'S SIGNATURE = 1° a 'c <br /> n � ao <br /> �I (date) <br /> ZONING ADMINISTRATOR � ��� `a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> T'e✓rn t 4- a I e fkl­ Pl c- c P 6t� J6e / H1111I7 fec o a o 0 <br />