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C � O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMIT _ <br /> OWNERI � TELEPHONE 5_ a , <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS�!/C!1 ?c►' <br /> LEGAL DESCRIPTION /((l. � o <br /> L.�J,?�BlocK�'i��Hber�-�ulb�ekS�S'ab-i?�u)'Is1x 1�vu> • <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE ❑ h <br /> �C. <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ C MMERCIAL A CESSORY TRUCTURE ❑ S � <br /> STRUCTURE/ADDITION USE: Al — c <br /> WC,bin; Commercial sines• room; Deck• .) <br /> BUILDING CONTRACTOR <br /> y <br /> A PLOT PLAN MUST PROVIDED ON AN 8'h X11 SHE OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 77 0 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <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 NEWo B <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O o <br /> AND INDICATE NORTH (N). J o c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) O <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. C7 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 3 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m Q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 ' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE ^L o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. ls <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN W y 1 <br /> NEEDED. (r� <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 0 z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. d = <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. Sac hat` hne seEbxKs T de s• /a' Fawn /are as VCtAds t 6J �eML SomeVhx, �' <br /> 7. > o o g � <br /> B � <br /> 1 dedare that this application(Including any accompanying Schedule)has been examined by me and to the beat of my g o,� ` B <br /> knowledge and belief R Is true,correct and complete. I admowledge that I am responsible for the detail and accuracy of all to C.E.t a : y <br /> Information contained In this application(Including any accompanying sdmdule)and I further declare that 1 recognize that this S> >m% y <br /> Information 1 am providing will be railed upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 8 5 c w V Ga <br /> further accept all liability that may be a result or the county of Burnett relying on this Information I am providing in this <br /> application. I agree to permit county officials darged with administrating county ordina aD $ $ t. <br /> access to Me above-described Lses at any bio time for the Wrpase of I Iv n c i5 Zi n- <br /> 7 <br /> p/p/m qJ / F3 ti75 > $ 8o`d'�J�-] <br /> OWNER'S SIGNATURE /r / tJ a I y > to D y M O <br /> K k �20i1 & �� Wr5 �, <br /> ZONING ADMINISTRATOR E R w' : S M <br /> BURNETT COUNTY 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 77nn(� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA2?NG ? U N oao 8 <br /> �3�0 aG <br />