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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a V� <br /> APPLICATION FOR LAND USE PERMITS n s —F <br /> OWNER TELEPHONE <br /> � (,Mond -f J-1 lyYle�sa., <br /> MAILING ADDRESS <br /> `2.J,q3^ Whim <br /> PROPERTY ADDRESS l./ (/� <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION 71DECK El GARAGE/ACCESSORY STRUCTURE ❑ r_ 7�) <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> � � y <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: n <br /> 3 3 A PLOT PLAN MUST BE PROVIDED ON AN 6 Y:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. *f <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 �� n F 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH (N). ` z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS) TO ALL LOT LINES, (B) BUILDING(S) 1 ° a <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK �- <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES i 4- <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. a <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. 1 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G P <br /> d � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. \ n 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 PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Vll <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. 4-C6tt+ (.q d 19L WV Lac- 4 6Jakj C(0ex G✓Gct,6dh RlFhe✓1� s <br /> 7. r'om333 ary <br /> r 3 3 3 S c 3 <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 F, <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of allW w r 'm_ P -3 <br /> Information contained in this application(Including any accompanying schedule)and 1 further declare that 1 recognize that this c a > > M, Y <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 a <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 1 am providing in this 1�1` b <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 premises at anyreasopq ble time for the purpose of Inspection. w 3 S g w 64 n <br /> o, ow , o _ > <br /> g R o > S <br /> OWNER'S SIGNATURE ZAS /C) a <br /> � > am � onr0 <br /> ZI/ �n (date) � <br /> 3 <br /> ZONING ADMINISTRATOR Elam" " n 6 zM <br /> M <br /> r � <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o N <br /> , 000 � � <br />