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li'1'� VVI`ri�l LiVvvi`\idt4 i:� N 9 Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3. <br /> APPLICATION FOR LAND USE PERMITS N <br /> m <br /> ' <br /> OWNER TELEPHONE O c)o <br /> MAILING ADDRESS 3311 <br /> PROPERTY ADDRESS 8 311 i5pan <br /> �baj(� UIJY,IVJ L V Ll 1- 0 — <br /> LEGAL DESCRIPTION NE 114 Iy W <br /> TYPE OF PERMTr(5): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY ST CTURE <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT CI <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTLRE 0 c <br /> STRUCTURE/ADDITION USE: GCr I Io (`�y <br /> (Home/Cabin; mercial Business; Bedroom; Deck; etc.) ((�" <br /> BUILDING CONTRACTOR, - In <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PILOT PLANS <br /> WILL BE RETURNED. <br /> m <br /> � 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tm p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW nt ' G <br /> BUILDINGSISTRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, B <br /> AND INDICATE NORTH(N). o z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 2 <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. 1O Q <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (OF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. N <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, C.,THE \ E <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DOME WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z O <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 /> AXI 9000 aO 'd <br /> 7. R � o333 ? � <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 Me detail and accuracy 000000ffffff all m m d' F ;, -7 <br /> information contained in this application(Including any accompanying schedule)and I further declare that I recognize t at this ° a a m <br /> Information I am providing will be relied upon by Me County of Burnett Wisconsin In determining whether to Issue a per It. I .. « ?m v y <br /> further accept all liability that may be a result of Me County of Burnett relying on this information 1 am providing In thisi c c H H `_^,�, 'b <br /> application. I agree to permit coun officials charged with administrating county ordinances or other authorized person to have ° m.p o $! 8 0 <br /> access to Me above-desQibed p 1 s at any reasonable time for Me purpose of Inspection. °� ,'d, S rW1 W N W n <br /> 1 . <br /> OWNER'S SIGNATURE i2 v �C'% �� (date) rA $S m( R 6 � 0 <br /> C `Z „lo'wO e , c� <br /> ZONING ADMINISTRATOR J'm I ��n( n y b 8 8 0° —n <br /> Eo . ^ ate <br /> TOWNSHIP PERMITS MAY BE REQUIRED n o, <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N »»H <br /> v 8aoo8 <br /> �E o <br /> 3c� <br /> o• <br /> 5 <br />