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H 9 �yZ <br /> 6 <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNERTELEPHONE ,. <br /> T7Pr�t/4Nce A. Er/Cff W <br /> v o <br /> MAILING ADDRESS&oy <br /> 3 r <br /> PROPERTY ADDRESS ,.r O ,3 J 6� 51 <br /> ` Rd 5 c <br /> LEGAL DESCRIPTION <br /> H <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING E ADDITION E DECK E GARAGE/ACCESSORY STRUCTURE E b <br /> a <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ r <br /> y <br /> IR z <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION E COMMERCIAL ACCESSORY STRUCTURE E V„ ° <br /> STRUCTURE/ADDITION USE: r' <br /> I tib ` o ' li U <br /> o a in; Ommercia usiness; Bedroom; Deck; e <br /> n <br /> :n <br /> 3UILDPvG CONTRACTOR: � 3 <br /> O � _ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/x X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAITS <br /> 6 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) to 'cam <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW y i <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, .o <br /> AND INDICATE NORTH(N). 0 Z 1 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(6)BUILDING(S) ° <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <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. , —1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> —7 G <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEPI <br /> NEEDED. r- i�✓`)I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: n <br /> ` Z d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I rA) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. SAI <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER C(7} <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 /> x > nnnn > ob <br /> O O ry G ry <br /> 7. R n ^ 9 3 3 <br /> 3 � � o m <br /> o : r <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my a a <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all $ _ n w c 2 <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> information lam providing will he relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I = ❑. N — "' <br /> further accept all liability that may be a result of the County of urnett rel Ing an this Information I am providing in this O o` o rrr <br /> application. I agree to permit county oKciais charged with ad nistratin urity ordinances or other authorized person to have m > Fn w n <br /> access to the above-described INSHIP <br /> iy reasonable time r the Pu a of inspection. _ �� n y <br /> r <br /> OWNER'S SIGNATURE •IL n „ c l m n Q � M z <br /> 2 Ta ' a M <br /> 20NING ADMINISTRATILf� °o : � � : E Ci �7 <br /> v y l�1 <br /> JUN 2 0 2012 <br /> PERMITS MAY BE REQUIRED g <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSCE ^N = <br /> �URNETTCOUNTY <br /> ZONING <br />