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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITSZ 0' <br /> n m <br /> o <br /> o � <br /> OWNER pp TELEPHON(7/ <br /> ""���� <br /> crat �c� pe5f <br /> �/1035-73 -7/ v _SZ <br /> MAILING ADDRESS 3 _L y � A 11 / �� <br /> D31/ ora a /r W(bs c� <br /> PROPERTY ADDRESSOL eirl e C) <br /> e O <br /> LEGAL DESCRIPTION L�7 Csm / .2,7 ` rrn yRr*0 ' [',MVAr f a G <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING C ADDITION C DECK V, GARAGE/ACCESSORY STRUCTURE C -. ✓� <br /> BUNKHOUSE C 59.692(1V)GAZEBO C STAIRS C FILLING/GRADING C CAMPING UNIT C p <br /> COMMERCIAL BUILDING C COMMERRCIAL ADDITION C COMMERCIAL ACCESSORY STRUCTURE C c <br /> STRUCTURE/ADDITION USE: 'Lbe-c- <br /> 9 <br /> o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.)Ca <br /> BUILDING CONTRACTOR: J e/ r CIJ� <br /> Jl <br /> 0 6 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o _ <br /> WILL BE RETURNED. �n <br /> r, c <br /> a <br /> f c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ^- 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, O J a <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) Q ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 'o O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. Q� p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 90 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 00 <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN C <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. ,z Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 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 p I <br /> SETBACK AREA. ^ <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. -4 <br /> NOT TO BE USED FOR HUMAN HABITATION. �E <br /> 6. <br /> 7. i > o 0 o m > 0 b <br /> n Q333A a £ R1 <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my g o,°Z ; R <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Ar- ER F <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this c `_ > > m , <br /> Information I am providing will be relied upon by the County of eumett Wisconsin in determining whether to Issue a permit. I .� ;, $ = ! 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 1 am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described re ises at any reasonable time for the purpose of Inspection. ((�� o o <br /> P� nm > 000 � o �j <br /> OWNER'S SIGNATURE S/// D n >> d <br /> aoWd � d = z <br /> (date) _. <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED a G "° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N o N o <br /> PC/m1� *Ie pnaa7_d fo <br /> V : <br />