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N b z <br /> � � o <br /> a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> n a <br /> OWNER t 1 TELEPHONE <br /> MAILING ADDRESS0 "-ej� <br /> �, �lohn J�� q -5p) ; <br /> PROPERTY ADDRESS 1st�r <br /> LEGAL DESCRIPTION �e S C' <br /> Y. Lo+ x C_L U <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> — y (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ��.AC_ C G',S4-�CJW_, 1 ,,c • ti <br /> O � <br /> 77 < <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. a <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. m �% <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW a � o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, J c <br /> AND INDICATE NORTH(N). o '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 p0 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. Al <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 <br /> v <br /> NEEDED. "11 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: US m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. (7 n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 1 <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 /> 7. z 0 0 0 0 a O b <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 a O ? w' <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 `9 �. D m N : Y <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit I <br /> further accept all liability that maybe a result of the County of Burnett relying on this information I am providing in this Q <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to <br /> have access to the above-tle premises at reaso able time for the purpose of inspection. W = c N w () <br /> 6 O 0 0 0 y <br /> OWNER'S SIGNATURE <br /> (date) n�nD w aU Z <br /> 20NING ADMINISTRATOR ^ ' Fa(04 <br /> 37 ,7 <br /> ,.� ? c a'o w m tz] <br /> TOWNSHIP PERMITS MAY BE REQUIRED NOV 2W " <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU g <br /> BURNETT COUN N <br /> ZONING <br />