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_ z <br /> 3 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator - - <br /> APPLICATION FOR LAND USE PERMITS = <br /> OWNER19/eV QN .'. lam✓ II !I TELEPHONE \ <br /> �Sr L.r:/�'1 �d T <br />' MAILING ADDRESS (. V ) / ,1 <br /> PROPERTY ADDRESS <br /> jL, g�S- P4hfn Su�[4 /ted <br /> LEGAL DESCRIPTION � / c—sf W P/03 <br /> w <br /> TYPE Or vERMn(5): SINGLE-FAMILY DWELLING ❑ ADDITION❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE 0 59.692(lV)GAZEBO 0 STAIRS❑ FILLING/GRADING 0 CAMPING UNIT EI •� <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 - <br /> STRUCTURE/ADDITIONUSE: '54- f/AII4- <br /> (Home/Cabin; Commerdal Bushes; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: (,'"k'Zii,.Tr i <br /> O <br /> A <br /> A PLOT PUN MUST BE PROVIDED ON AN 8 V.%11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS <br /> WILL BE RETURNED. '^ <br /> r _ <br /> DIRECTIONS FOR PLOT PUN DRAWING: (AREAL OR TOP VIEW) e <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL DUSTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). c <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 <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(OF),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 <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. <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 <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. <br /> 2, 9 > Mnco > cT <br /> I declare[M1ai this application F S <br /> pp (including any accompanying schedule)has been examined by me and to the lust of my <br /> knowledge and belief it Is true,correct and complete. I acknowledge Mat 1 am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and l further declare that l recognue that this _ = <br /> information I am providing will be relied upon by the County of Bumett Wisconsin In determining whether to issue a permit. I _ _ ,> <br /> further accept all liability that may be a result of the County of Burnett relying on this information l am providing in Mil __ � <br /> application. [agree to permi county officials charged with administrating county ordinances or other authorized person to <br /> have amass to the above-de dpremises at son�leti (\qtr the purpose of inspection. > ! = n <br /> OWNER'S SIGNATURE`- L..1 I\I V�'aJ� /0 - 0- -J01.3 <br /> 1 (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED = _ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ <br />