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v, ro z <br /> � � o <br /> a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <_. <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE /_ <br /> MT J �� ,i— 7 �1 aaG—loyr'7 o l <br /> MAILING ADDRESSAww t 3 <br /> L <br /> PROPERTY ADDRESS ✓✓�/��(( /r ` // ,[r'VO� jp�} �L' / \' <br /> 0 <br /> LEGAL DESCRIPTION �}— <br /> �v TLDTz S�nory/o, r�N �P/�i� X-, <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE _ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: �o.4 eF SA of <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/x X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> L� O <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 C> <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, W <br /> AND INDICATE NORTH (N). YJ <br /> o <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 p <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.5. INDICATE IF A WALKOUT BASEMENT I{�� <br /> S PLANNED AND <br /> 6. IF SEPARATE PLANS ARE SUBMITTEDIBY AN ARCHITECT,ENGINEEOW R, BUILDER,CONTRACTOD. <br /> RTO BE GRADED OR S ETC.,THE i v ' <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: 1 x <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ] h z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q H <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ��yy <br /> SETBACK AREA. Q <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 0 <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7 T p 0 0 0 a <br /> 333� m <br /> NN � <br /> I declare that this application(including any accompanying schedule)has been examined by me and tothe best of my 3F 0 ,P 4i � � <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all �, M <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this Ec a m not : Y <br /> information I am providing will be relied upon by Cou ty of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability that may be a resu a Co of Burnett relying on this information I am providing in this <br /> application. I agree to permit county o h rg administrating county ordinances or other ored person to ;; O m o : g <br /> have access to the above-described prem' a n nable time for the purpose of inspecti n— r-� _ w w n <br /> IIIr�C' � � SooScy <br /> OWNER'S SIGNATURE <br /> (date) <br /> APR25 a : W � � � _ z <br /> ZONING ADMINISTRATOR <br /> o = w <br /> TOWNSHIP PERMITS MAY BE REQUIRED SURNETT COUN <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING <br /> o: <br /> fA N fA fA�0 <br />