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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS N' isti <br /> o <br /> OWNER TELEPHONE <br /> 703-/9ZS <br /> o <br /> MAILING ADDRESS <br /> /9s T n lG, Fn z{ ,l3 fie/ /L/w �l Oyl <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION b5— 00/— p//700 c. <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> 9 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑// COMMERCIAL/ACCESSORY STRUCTURE ❑ o `� <br /> STRUCTURE/ADDITION USE: �` !%J" <br /> 0 <br /> (Home/Cabin; Comme ial Business; Be oo ; Deck; etc.) ' <br /> BUIIDiNG CONTRACTOR: in <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> 90 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW [e ado <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Cy p <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) °o P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK c <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 ) H <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE90 <br /> 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 DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. !; z <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. a <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. ab 8b ° a <br /> A n m 3 3 3 �•' an � <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my p o•°z P `��° 9S ?w= <br /> knowledge and belief It Is tore,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 dedare that i recognize that this " E.a c m <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I 5 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this a in in t2 b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have n n 0 8 8o t. <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. m w",-5R r1 <br /> . � Qy Sgogg � <br /> OWNER'S SIGNATURE a 6 <br /> > am � ET,,� 0 <br /> c � � <br /> ZONING ADMINISTRATOR 8'5 o n <br /> AU6 16 12 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAIMNETTCOU <br /> B000S <br /> ZONIN!(. <br />