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c � z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a �, <br /> APPLICATION FOR LAND USE PERMITS : <br /> OWNER A111�V TELEPHONE (1_3 —ZqZ O 1O.J m0 <br /> MAILING(ADDRESS V <br /> I 5 Gold s� 12c� i x Wt 5X1 30 <br /> PROPERTY ADDRESS ' <br /> o r� <br /> LEGAL DESCRIPTION o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 4 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDINGE) COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED <br /> rr <br /> STRUCTURE/ADDITION USE: VQXQ � c <br /> (Home/Cabin; Com ercial Business; Bedroom; Deck; etc.)1,� <br /> BUILDING CONTRACTOR: U S " y\\ n <br /> � N <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ _ <br /> WILL BE RETURNED. <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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, o <br /> AND INDICATE NORTH (N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUI LDING(S) _ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S <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 CY3 <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VECr <br /> RIFICATION MY BE DONE WHEN Gn <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r C <br /> � G <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. 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 <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. yy >o 0 onnaoro <br /> 51 R <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 allto m <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this m ° > > m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In cleternining whether to Issue a permit. 1 5 ? .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 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of inspection. E a r w n <br /> CU S-I �- f0 nA � agsosgy <br /> 9 '' wn y „ O <br /> OWNER'S SIGNATURE s (date) yc+ c <br /> ZONING ADMINISTRATOR Jim n( 5 <br /> z <br /> n t� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE »H <br /> 1 � 80008 <br />