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b z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator < \ c <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER TELEPHONE O <br /> MAILING ADDRESS ,/��l Is !_6 Q W 5 <br /> RU, W�J'e� ) 1yo3 1 <br /> (0 O V K.l <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> PEI C(- �.. � , e� 2S - 7-ya A. l`ZI — <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ 1 ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ 1 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: �� � X�� I �Gk- <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) CS <br /> BUILDING CONTRACTOR: e I n <br /> O 4 <br /> A < <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. 'n <br /> ` a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW CT o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, .a <br /> AND INDICATE NORTH (N). c z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S) R. ° <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O G! <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <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. 1 -C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE (A kA <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (JI� <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 8 F CY <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> n z G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N 'A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. b <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER q <br /> SETBACK AREA. Cl <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. > 0 0 0 L c O -0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my p <br /> knowledge and belief R is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all p v E. E. y <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this `9 E. 5 D o N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m L' '9 <br /> further accept all liability that may be a result f the County of Burnett relying on this information I am providing P ty Y ff tY Y 9 P 9perso <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to m m <br /> have access to the above-described Osesjt any relona le time Tor the purpose of inspection. w N w () <br /> i/ II W <br /> OWNER'S SIGNATURE 1%C//'�r��� <br /> (date) y O <br /> a : � dRd . z <br /> ZONING ADMINISTRATOR o a .H o 'tLc sl <br /> o C, M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE l O <br /> Yi�N69 dim <br /> tJivNi O � O O <br />