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9 Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g P <br /> APPLICATION FOR LAND USE PERMITS y UJ <br /> OWNER / �, �rf / ,�-(�c/�O /- o!/'„ane` I TELEPHONE q = d <br /> MAILING ADD-R(E/B-S BYen� �iILI�'lUln .-IL)(f llati btitrV 61103n <br /> PROPERTY ADDRESSag( 8Cr>jam in &;e � .17 J <br /> I 1 <br /> p � � <br /> LEGAL DESCRIPTION �' 4 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ElADDITION ElDECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> 2 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ �' -{- <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: Pb�e JI �,d <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (� <br /> BUILDING CONTRACTOR: <br /> n <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. _ <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r' " <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v <br /> AND INDICATE NORTH (N). N c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(5)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O O <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 J <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. rn <br /> 5. INDICATE IF A WALKOUT BASEMENT 15 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. (� U <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: O v <br /> F <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <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 I .� <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. T o 0 0 o n a 0 7 <br /> a <br /> I declarethat this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 � = � 'o <br /> knowledge and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a m a EL R <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this a e a 9 m N a <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I $ ry <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 N :n:n '_^n 'V <br /> access to thon.e above-desee to permit cribed premises at alny Treason bleed htime administrating <br /> thepurposeof Irnspecion nances or other authorized person to have o d o o <br /> m w o w N o o <br /> OWNER'S SIGNATURE ° _ O <br /> n D <br /> (date) °c °'y '°Fa F - 3 Z <br /> ZONING ADMINISTRATOR J,m <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` a. <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE " <br /> le,-I'kf1o(cY-,°el cLP r1_1�-dkboraG, <br /> S000S <br />