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N z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER1 EC Le fa <br /> G I� TELEPHONE o <br /> MAILING AD ESS ai2 <br /> PROPERTY ADDRESS / '•71"t <br /> 6ree� d o /V <br /> LEGAL DESCRIPTION C /L -T <br /> /� �y / o m � l /'5-co <br /> TYPE OF PERMIT(5) SINGLE FAMILY DWELLING9 ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE." R.m <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ �1 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ -�-- <br /> STRUCTURE/ADDITION USE: i n k 1 Z �. <br /> Q (Home/Cabin,Commeraal Business; Bedroom; Deck; etc.) (� <br /> BUILDING CONTRACTOR:_ I J/a <br /> lI-LVdL L 2 � � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. 0 � c <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 r, "° ., n� <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3 ' <br /> AND INDICATE NORTH (N). N 1 B <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w' 1 <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. <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I C�) <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> r 1 ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. )Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY _ (S <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER PERMITTED. <br /> SETBACK AREA, <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. () <br /> 6. Nu) C.vwr os G� 6� �pK.0 bxlc xro ' fis w4 bar �4cct . �{4 /c I" <br /> 7. <br /> 4nfl 5c t 7Satf <br /> s � a000 ° a ° ° <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my e <br /> knowledge and belief it is true,correct and complete. I acknowledge that I 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 `�° E. <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o. ii c off—._' D <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this ' H n w <, � � 'C <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to n 'm N <br /> �° 4, : <br /> have access to the above•describ remises at any reasonable time for the purpose of inspection. m > dIN <br /> f7 <br /> OWNER'S SIGNATURE <br /> (date) <br /> (date) 69 D'� <br /> ZONING ADMINISTRATOR ]f �� x(J �r'/ <br /> OCT 15 2012 <br /> TO NSHIP P RMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSLMp& "— <br /> ETT COUNTY <br /> ZONING <br /> �� 00000 <br />