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P <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS ' <br /> N <br /> C <br /> I II11 TELEPHONE <br /> OWNER ++ ��..� f�.�( `ST'(�Q ,ICY '� 15 -d�IB. I� <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS 0 <br /> _ p <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE-6- <br /> BUNKHOUSE <br /> TRUCTURE0BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 (b <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED fD <br /> STRUCTURE/ADDITION USE: z <br /> 0 <br /> (Home/Cabin; Commercial Business a room; Deck; etc.) <br /> BUILDING CONTRACTOR: land &A ; Ja7cigs <br /> r7 <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS a <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, o- v <br /> AND INDICATE NORTH (N). J z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) a ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w'' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. C? p n` <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 O \ o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 7} <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CJ'1 J <br /> r- 1 <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. O d S r <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 C <br /> SETBACK AREA. J' <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p <br /> NOT TO BE USED FOR HUMAN HABITATION. G <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my 3 0 ° o ;, S no <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 <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 may be a result of the County of Burnett relying on this Information I am providing In this 9. <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ^ <br /> access to the above-described premises at any reasonable tim for the purpose of Inspection. F <br /> rJ >00000y <br /> OWNER'S SIGNATURE ? m 3 H = Z <br /> d <br /> ZONING ADMINISTRATOR <br /> OCT - 6201EL <br /> TOWNSHIP PERMITS MAY BE REQUIRED `a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEBUNF r N ti o N o <br /> 0(rot'� 4-1e.-W� maIUA fv ��y Keller/o-/6-0 >�IN% 0000 <br />