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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PERMITS U" <br /> m <br /> � C <br /> OWNER <br /> f P,Sa T,��U TELEPHONE�'j� <br /> MAILING ADDRESS y f <br /> PROPERTY ADDRESS `0i �g o , <br /> LEGAL DESCRIPTIONLot co j (( o�;`. ` �, r <br /> clk <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ITIOND CK ❑ GARAGE/ACCESSORY STRUCTURE ❑ .. w <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED r" <br /> STRUCTURE/ADDITION USE: �ei rik c c <br /> (Hom b1 Commercial Business; Bedroom;; Deck; etc.) F P T <br /> BUILDING CONTRACTOR: Q- (., CO <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS I/1 0 <br /> WILL BE RETURNED. <br /> +f <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE, c <br /> y0�S2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW m 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Q o 0 <br /> AND INDICATE NORTH (N). a N Z <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 9- w L <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p d <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> ff�� <br /> ��'NOTE: BUILDING STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN oo '' <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (� <br /> F <br /> q 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> V� 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z S <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, <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. J <br /> /N�OT TO BE USED FDR HUMAN HABITATION. + p <br /> 6. 4ijj'�dn TOTe5s t6, A . <br /> 7. 6,4- ^ � > r) r) > u> v <br /> n <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it Is true,correct and complete. [acknowledge that 1 am responsible for the detail and accuracy of all (i m r & r <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this m 6 a <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I �- ?qT < 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this c `_^ <br /> application. I agree to permit county officials charged with admini rating county ordinances or other authorized person to have <br /> access to the above-described premises a any reason Ime f he purpose of Inspection. °� di2 w w N. r1 <br /> A A y> O �r: pO rnO O I> <br /> OWNER'S SIGNATURE �>✓ /O / U, <br /> 6mm0 <br /> (doe) o $ `� 3 A _ <br /> ZONING ADMINISTRATOR <br /> A � rata <br /> TOWNSHIP PERMITS MAY BE REQUIRED si <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C ^ <br /> U H O O O O O <br />