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o Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g ; P <br /> APPLICATION FOR LAND USE PERMITS C� <br /> -'� I T I / n <br /> OWNER Ol �e� l TELEPHONE8C( -7391 d <br /> m/ 1 1 r 1� ( J p ( 0 <br /> MAILING ADDRESS -P O. Sax D , U-') <br /> \ e� t0i et, ({�.I ✓ �(.` D L <br /> PROPERTY ADDRESS `�CJ�\may J ,OW o a <br /> b 6 < <br /> LEGAL DESCRIPTION 513 T Sl N R 14 w off 100`. l..J i4o` S C N U/ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ , <br /> b <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> II y <br /> STRUCTURE/ADDITION USE: t'C�Ove \ O 0.Y aj leI a. Xa c <br /> (Home/Cabin; Commercial Busi s; Bed m; Deck; etc.) <br /> BUILDING CONTRACTOR: tAJ 2 y <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS a <br /> WILL BE RETURNED. n <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) d <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 mO <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). co <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ao d <br /> LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSONS. <br /> 4. SHOW T EFLOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (D)I AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. = �' <br /> S. 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 '" E <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. vV ' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN H <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. F, 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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. `d <br /> t"I <br /> � zonnnso; <br /> I dedare that this application(Including any accompanying schedule)has been examined by me and to the best of mya..,. <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all " is m °=i": -3 <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I mmgnlze that this " ° a a <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I "e w 5 ; 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this °c c H N: w N .0 <br /> application. I agree ro permit my officials charged with administrating county ordinances or other authorized person ro have " q 8 8 H 'A <br /> access to the above-des pre es at any sonable Bme for the Durpose of Inspection. 3 m E c goo 8 <br /> 0 <br /> OWNER'S SIGNATURE n a^ a c t "" <br /> 6, <br /> (date) 8 g w g R F,= x <br /> o : 2.N a=-zl <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />