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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNERTELEPHONE <br /> DA'V► 1) til 7�T " Cn <br /> �7�1�Y369 <br /> MAILING ADDRESS1&567 �� 11 <br /> �akt1 �_ � <br /> l I r <br /> PROPERTY ADDRESS 1 Pj� kfjD I I 11 r )f/�}. ` 7 I7 <br /> o <br /> LEGAL DESCRIPTION � <br /> �o y Carla 1 Vt4d , P►C�v 1 S5aW <br /> TYPE OF PERMIT(S); SINGLE-FAMILY ELLING D AD TION D DECK D GARAGE/ACCESS RY STRUCTURE D v: <br /> BUNKHOUSE D 59.692(1V)GAZEBO STAIRS ❑ FILLING/GRADING D CAMPING UNIT D <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> r t (Gt e e. <br /> STRUCTURE/ADDITION USE: SP1'<K(One t� sic cL�dl�- �����, �, z <br /> (Home/Caabir Commercial�uslness; Bedroom; Deck; etc.) ° <br /> BUILDING CONTRACTOR: SCT = own 8P____ �� <br /> U <br /> � WF <br /> o J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 �/x X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. — <br /> Y, C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 tin o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). J Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 9 P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK }U F <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. 000000 C <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. b <br /> i r <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. 1F SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. f^ <br /> NOTE: NEEDEINNG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> vl i <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: 47 d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. U; d z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. p <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. OJ <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. g <br /> 7. � ? Dr7a c C] a JC b <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my3 0.z <br /> knowledge and belief It Is true,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 declare that I recognize that this d <br /> .o o,D a F <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 .. _: <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 /> 0 <br /> g o o o <br /> access to the above-described premises at any rea noble time for the purpose of inspection. <br /> 3 ry D ? o H <br /> OWNER'S SIGNATURE (Q 2 A a <br /> da[ ) o to D <br /> ZONING ADMINISTRATOR_31 I _i F <br /> rn <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DAT OF ISS ANCE <br /> &vl( MvSOr) 10 —ll oo � o <br />