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ro Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS a l� <br /> OWNER A , / 1' TELEPHONE C �� <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS '• ^ <br /> LEGAL DESCRIPTION f-4 c— <br /> A,jq he ._-f_S;r,I 1c vi",A 5/ XP i iS t S 1 Fe <br /> TYPE OF PERMIT(s): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ D� GARAG /ACCESSORY STRUCTURE <br /> � f <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> C\ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: z ,� <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: /11vS r CGn S 'iaG t r °'l <br /> r N x <br /> o � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) D a <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 M w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 <br /> AND INDICATE NORTH (N). 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 <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 5. �� <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 / 4 o <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. C i <br /> L -C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> F N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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 HUOAN HABITATION. <br /> 6. jj 'I'LS f- 6¢ -7S ' }YOrn bva((vja:, �`j�T �,�a_} c/ c✓Ct: E <br /> �'J� hah, f�.4 ty jlv� S ace_ ;n t6iIS arc. Y ctec4rttcP; <br /> 7. "7 F 5 > 000 � aoro <br /> I declare that this application is true, <br /> (Including any accompanying schedule)has been examined by me and to the best of my 3 p Z <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Www_ F y <br /> information contained in this application (Including any accompanying schedule)and I further declare that I recognize that this .��. D W `D <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I d -tea a c^ > <br /> further accept all liability that may a result of the County of Burnett relying on this Information I am providing in this ! N 7 <br /> application. I agree to permit cou ty�fficials charged with administrating county ordinances or other authorized person to <br /> have access to the above-clescrib d p emises at any reasonable time f the purpose of inspection. <br /> OWNER'S SIGNATURE <br /> n a � <br /> (date) <br /> I / o <br /> ZONING ADMINISTRATOR .�J <br /> c <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> ,C'/✓n_L � -1 li' � � l�i'L�.il-�'c� t� �C4� /-�eFdl� /O - �� -0� CNti00000 <br />