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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator - <br /> APPLICATION FOR LAND USE PERMITS "E <br /> OWNER ; TELEPHONE 763 -S'Z7 SZ3y' _ <br /> 11�rhq Akrolfl -763 -Y,-Z -12c5 CES o <br /> MAI4ING ADDRESS <br /> WZ(i iv3�0 cN N(,) RAMsFrr mN h53o.3 <br /> PROPERTY ADDRESS <br /> Eels oR , 5ve43 <br /> LEGAL DESCRIPTION _ <br /> TYPE OF PERMIT(s): SINGLE-FAMILY DWELLING 0 ADDITION ❑ DECK 0 GARAGEIACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDINA "COMMERCIAL ADDITION IT COMMERCIAL ACCESSORY STRUCTURE❑ 9 <br /> STRUCTURE/ADDITION USE: 57�� � y�JXyFi'x /fj z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: YOUR U.`AY RUIcOfI?S cNLck IULSEI\ z <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN R`/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS r'. S <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, C3 <br /> AND INDICATE NORTH OU. <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) r <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK - Q� <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 -_ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I� <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. Z i <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 RESIDENRAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. y7> > nnr c r <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 e .. _ <br /> knowledge and belief it is true,correct and complete. Iacknowledge that I am responsible for the detail and accurary of all g <br /> information contained in this application(including any accompanying schedule)and ifurther declare that i recognize that this = > v_ �'c„ ' <br /> information 1 am providing will he relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 _ = S <br /> further accept all liability that may be a result of the County of Burnett relying on Nis information I am providing in this6 _ Nq <br /> application. I agree to permit county officials chan,q with administrating county ordinances or other authorized person to <br /> have access Wthe above-describ dpramises ata ble time far the purpose of inspection. F > N (] <br /> OWNER'S SIGNATUR MY <br /> �jy (date) <br /> ZONING ADMINISTRATOR .%�GGH' JUN 9 2014 v _ <br /> ' - I R <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT GOU - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING <br />