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° O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PERMITS = ll <br /> �j <br /> OWNER TELEPHONE <br /> o <br /> MAILING ADDRESS <br /> C 4 <br /> PROPERTY ADDRESS = j _— <br /> Slin, P o <br /> � J T <br /> LEGAL DESCRIPTION � o C.' CV af Cs-M !//Ll ✓� s 2 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK O GARAGE/ACCESSORY STRUCTURE ❑ h "� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO D STAIRS; FILLING/GRADING D CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o '3 <br /> STRUCTURE/ADDITION USE: StG '�i p <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: SP r7 <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANSo <br /> C <br /> WILL BE RETURNED. 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tnn o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. R n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW to w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ? <br /> AND INDICATE NORTH (N). o Uj o <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 5 <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 nO(1 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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. UJ <br /> d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y i <br /> NEEDED. ti <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> _ ) p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, n Z k. <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. T <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. r <br /> 6. _' 1 rS 4-o b c v7 p o s)-s U t,CL L'✓I c�Q <br /> 7. > � 0000C)aa -V <br /> 0 fm <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. I acknowledge that I am responsible for the detail and accuracy of alla `p: E R a, y <br /> Information contalned in this appllcation(including any accompanying schedule)and I further declare that I recognize that this .� �_9 D <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I ,��, w 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 <br /> application. I agree to permit county offici Icharged with admi istrating county ordinances or other authorized person to have <br /> access to the above-described premises any reason"tlm or the purpose of Inspection. m w w N w <br /> o o w o 0 <br /> 'm S a <br /> OWNER'S SIGNATURE f l'� �� / a O <br /> _ (date) <br /> ZONING ADMINISTRATOR �J I W) t 011 I L� i`1 y Q? N c °° y ° O t"I <br /> TOWNSHIP PERMITS MAY BE REQUIRED �I <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �� Soo�S <br /> Pern­li� Pc�c�� i'LP <br />