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uiv L uwlru i tKiSCANNED <br /> Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> 1 APPLICATION FOR LAND USE PERMITS =: <br /> OWNER /l LlTELEPHONEIS_ <br /> G / 6 „6 <br /> L1J e r`rS 6Y�� p Y' V dp <br /> MAILINGADDRESS <br /> n 1 <br /> PROPERTY ADDRESS <br /> 6 ll I l� blJ o T <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMIL DWELLING ❑ N ❑ DECK ❑ GARAGEE/A/CCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 13 STAIRS ❑ FILLING/GRADING @' CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: Iue— <br /> (Home/Cabin; Commerci I siness Byedroo..�/T/, Deck; etc.) V <br /> BUILDING CONTRACTOR: �tJQ I ��-l[U — p <br /> n <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. '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. c d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEWjw <br /> 0 " 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N I 'Y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) J <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. p <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. v' <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 9L) o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. f ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Q z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TOE USED FOR HUMAN rABITATJON. / <br /> 6. yr TZ, JJ2/0/&�e &p_1- 2LlL 3�,o Crl v e -r <br /> 7. 1J � > > <br /> n rt <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my g o,°� S? w <br /> knowledge and bellef It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all c m E. = E o, y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .� c,9 D W N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .c 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this o $ 6,N '`_1 N 'd <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 &a;ta7nyManable time for the purpose of Inspection. COWNER'S SIGNATURE <br /> (date) o $ <br /> C.on <br /> ZONING ADMINISTRATO A <br /> R C:y <br /> IN <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �� 800 8 <br /> Our /2�!� <br />