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c r'o z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER /� ',y, I,l_ �n -J 9eq r /� I !`rI-��m TELEPHONE a d <br /> 1Vbtly � / 0 1JOh 's O <br /> MAILING ADDRESS (Ta, lrla✓ sh 2� lAJI6,S <br /> PROPERTY ADDRESS 6R m I <br /> VLI' W a � , <br /> < C>0'� <br /> LEGAL DESCRIPTION S' -d <br /> TYPE OF PERMIr(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE r <br /> BUNKHOUSE O 59.692(1V)GAZEBO 0 STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION <br /> C� �7 ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: hG _IA/ 1 y <br /> (Home/Cabin;Commercial Busin ; Bedroom; Deck; et <br /> BUILDING CONTRACTOR: <br /> n � <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o � <br /> WILL BE RETURNED. y <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 I d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v <br /> AND INDICATE NORTH(N). /' z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S) 0 <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. d <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. 5. <br /> 5. INDICATE IF A WALKOUT BASEMENT I5 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN W <br /> NEEDED. <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. y C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. A �' <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 /> nFzp,nn � oo ' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge 3 0 <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I v CSS D c w N <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit I further accept all <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for the purpose of inspection. ° d <br /> > $ 808 $ : <br /> OWNER'S SIGNATURE ^/�/ n �l.(.C.f ,V v� 7- 1 Q m 3 p <br /> (date) o v 5. <br /> �JII) ) i �an(6I &h a ) <br /> ZONING ADMINISTRATOR ,', 00 � o ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0? <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Js /�� H �» <br /> (� r Glee b S/��h 0 h v <br />