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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ° <br /> APPLICATION FOR LAND USE PERMITS m <br /> OWNER ' / TELEPHONE <br /> MAILING ADDRESS <br /> ZS` �75 ' Co <Yr�lf� <br /> PROPERTY ADDRESSS.�, <br /> LEGAL DESCRIPTION 9 Zg /y IV <br /> TYPE OF PERMIT(S): SINGLEDFAMILY DWELLING ❑ A DITION X DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ vn <br /> BUNKHOUSE 0 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING 0 CAMPING UNIT❑ <br /> v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: Sc- X��e)-y Yee,C'& 'Z <br /> 0 <br /> (Home/Cabinyr'Commercial jBusiness; Bedroom; Deck; etc.) <br /> `v �l <br /> BUILDING CONTRACTOR: rO /, 0 TC •( L'f <br /> tv 7` 2 y Sc o rf- D.C. Seo oA'eC w, `7i S= 411t qe, o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O o <br /> WILL BE RETURNED. 0 _ <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m c <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 /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Q a <br /> AND INDICATE NORTH (N). z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) cc o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK QJ 5. <br /> 90 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. -1 p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES I '^ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. °_ H <br /> 5. 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 o <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: . r. ('*Cf' 7 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n 2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER O i lJ1, <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, P;I > ononaoro <br /> $ n 3 3 c <br /> H n � E3 E3 <br /> I dedare that this application(including any accompanying schedule)has been examined by me and to the best of my g o,°Z R R R ? w <br /> knowledge and belief It is true,correct and complete. I acknowledge that 1 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 `0 c_aa m 'O a <br /> information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I N u w .Q <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this it 'ky ,,,to '_^N 'q <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have n c o 0 0 0 .r, <br /> access to the above-described premises at any reasonable time f r e purpose of Inspection. m c o W,w o000ooy <br /> �l�2Jf / �C�GL `3 f� 3 m > o y <br /> OWNER'S SIGNATURE �� ��•' f° '? <br /> y, yf. mn v,m0 <br /> (date) <br /> a is N <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N N o a N N o <br /> 0 0 0 0 0 <br />