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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS G' <br /> OWNER 8C& r`I )r lO N_1 oUj:t 1 4,LVIG4� AkL60 , TELEPHONE `j) .Y� ' O v l <br /> MAILING ADDRESS dl 33 2tN M I ` 4 '1� R / �1�'ea �J�,� a SJ�f 872 '4 r <br /> e( ✓ ate+ 4 A � <br /> PROPERTY ADDRESS U <br /> LEGAL DESCRIPTION c 0 <br /> 1 9 V7-01 -fig`15=1 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GA E CCESSORY STRUCTUREA -. -- <br /> BUNKHOUSE <br /> nBUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ F[LL[NG/GRADING ❑ CAMPING UNIT❑ <br /> v <br /> COMMERCIAL BUILDING ❑'' COMMERCIAL ADDITION [I COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: cme Z <br /> 0 <br /> (Home/Cabin; Co ""c�ercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: V--: OL / CO I� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rft X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m ' S <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 a <br /> AND INDICATE NORTH (N). c <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 <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 �, F „ 1 <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 ..l 1 <br /> NEEDED. f �, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C <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. '� D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. r (v^I <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. z > r 0 o u c 0 b <br /> xr K333c ^� = 'A <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my g o g <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am res p <br /> g P g responsible further <br /> for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and t further declare that 1 recognize that this 5.,a a m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d 'a w` ,9 <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this <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 time for the purpose of Inspection. <br /> f3"l m'Ni7 a D <br /> OWNER'S SIGNATURE > $=: <br /> Wc r� o vin <br /> a O d <br /> (date) � a = <br /> ZONING ADMINISTRATOR I �Cit71 qa f N 20w : <br /> = <br /> U P <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> T�4S PERMIT SHALL EXPIRE ONE YEAR FROM T OE F ISSUAN <br /> ,c b1 NVfM69� <br /> FP,(mi �a�rru�-1�+.✓z'l <br />