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C V <br /> O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS y <br /> OWNER WILLmwj Arv�old _IV'. TELEPHONE .715866-7Z3S o <br /> O <br /> MAILING ADDRESS <br /> Z8z90 S+bZ- 'e_ Rd 3S DahltL,r, WI SyS3o <br /> PROPERTYADDRESS Zg290 5{-a{"� Rd 3S <br /> 0 <br /> LEGAL DESCRIPTION -'j"0.% �O it- 0"1 -0 20 - 013 f-1 G 9 <br /> TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING'S ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ lL— <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o <br /> 3 (_7 <br /> STRUCTURE/ADDITION USE: O C CL' t5 c <br /> (Home/Cabin; Commercial Business Be room; Deck; etc.) r s, <br /> BUILDING CONTRACTOR: n C) <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o — <br /> WILL BE RETURNED. +f <br /> +l n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) rz <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, v <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w' , <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m <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 1 <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> 71�- <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. K <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` L <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. � � �o oe aC7S <br /> Rn y3� 33 a � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that thism �.D D m N <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .�a <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this % � w N: ='N t% <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have n � 0 8: $ 8 <br /> access to the above-described premises at any reasonable time for the purpose of inspection. 3 �� > <br /> OWNER'S SIGNATURE � .%�lt <br /> nus 92: <br /> (date) <br /> 95 3 fi z <br /> I <br /> ZONING ADMINISTRATOR 1(y) Iq w : &°�0 , ° <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N H <br /> � � 80008 <br />