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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE (p 1 a <br /> MAILING ADDRESSp <br /> `2 /73 s% cST. e 70,(J v�5ii <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(s): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ �, 1;,171 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ O <br /> STRUCTURE/ADDITION USE: '7f ��gso,tl Lao 4( ' <br /> (Home/Cabm, Commercial BUSIneSS, Bedroom; Deck; etc.) <br /> I <br /> � <br /> BUILDING CONTRACTOR: _Z/0L- LL �r..�/ ij <br /> 2 A <br /> Mhn �p a `1/olog Lon CakeTr � t�znbur <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN o Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLS IBLE PLOT PLANS c - 1 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> n a <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 <br /> y � <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK S) <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 Qa <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. v, 9.J <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN �J <br /> NEEDED. Iti <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. 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 WATERF>� � <br /> O <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. <br /> oo �aI declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 9 e nknowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Amo'o'R 'n ,n ? wInformation contained In this application (Including any accompanying schedule)and I further declare that I recognize that thisD Co `D :Information i am providing will be relied u tyurnett sin in g p > "further accept all liability that may be a result of he County of Burnett elyingWisconon this Infomation I am providing in thismit I as Zapplication. I agree to permit county ofndals charged with administratingcounty ordinances or other authorized person to have o; $ $access to the above-described premises at any reasonable time for he purpose of inspection. o f9 W N�OWNER'S SIGNATURE 'Awl (�� S o $ $ <br /> a6 d <br /> a ViYo;mn�v, <br /> ZONING ADMINISTRATOR /!m I C( {�( (date = c <br /> TOWNSHIP PERMITS MAY BE REQUIRED �' w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �°✓✓vii-F �- l e-I'�/171 ac�e�� /72ar� ,/n �, _ ��,�,�,.. <br /> � ,�3✓7ic 'T30 - 6g � a $ 000 $ <br />