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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator zi <br /> v o <br /> APPLICATION FOR LAND USE PERMITS n <br /> OWNER ���11 �rom /_ )e�TELEPHONE <br /> MAILING ADDRESS 0555 J�JX �UY�iSf Lk <br /> PROPERTY ADDRESS O '1 <br /> ///��� p�raf cL�S _ 2 <br /> LEGAL DESCRIPTION p' <br /> c- w ^ ' F2 N W N 1 ,vy A) <br /> TYPE OF PERMITS): SINGLE-FAMILY DWEWNG❑ ADDITION DECK 11 GARAGE/ACCESSORY STRUCTURE <br /> Y <br /> BUNKHOUSE ❑ 59.692(1V)GAZE80 ❑ STAIRS❑ FILLING/GRAO[NG O CAMPING UNIT❑ rb <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION Cl COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: S 1" ISS S`Led I X I" <br /> Home/Cabin; Commercial Business; Bedroom; Deck;etc.) `. <br /> BUILDING CONTRACTOR: e IF s <br /> 'n S <br /> z < <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V.X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n <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 o <br /> BULDINGS/SERUCIURES(NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). 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 <br /> (OHWM)OF IAKE,STREAM OR RIVER AND WETLAND AREAS,AND(0)LOT DIMENSIONS. 1 O <br /> 9. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISEANCES <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 <br /> PIANS MUSE BE SIGNED AND DATED BY THE OWNER. l C3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN SO O <br /> NEEDED. - W V) <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: "C <br /> z r- O <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN AL DAYS OF PERMIT. v V1 <br /> 2. REMOVAL OR CUTTING OF LATREES AND VEGETATION O RED UNLESS ALONG SHORELINE. ^ <br /> 3. NO GRADING ESS INCLUDING ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY REQUIRED <br /> WATER 9. NO BACK A ORES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SCCESSOAREA, <br /> 5. ACCESSORY SEA PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USEDD FOR FOR HUMAN <br /> HA HABITATION. Q <br /> 6. <br /> 7. z > nr: nn 6s <br /> R n ^ 3 <br /> " 3 3 3 0 = Z <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accurary of all _ .3 <br /> information contained in this application(including any accompanying schedule)and I farther declare that Irecognize that this 5 acg Y <br /> information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a Permit. I <br /> farther accept all liability that may bearez itofthe county of Burnett relying an this information I am providing in this <br /> application. Iagreetoper it ntyo harl <br /> a cgewith a demonstrating county ordinances or other authorized Person to <br /> have access to the above• Led pre i at any reasamable time for the purpose nspoctioa fid c dy : - Hwr) <br /> OWNER'S SIGNATUm �— <br /> 3 nm o oy <br /> (date) <br /> a <br /> ZONING ADMINIST OR 7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED n - - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE d c, <br /> ly lu �o <br />