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n -3 Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 35 <br /> —� APPLICATION FOR LAND USE PERMITS = U <br /> OWNER eje le _ CQ TELEPHONE �_ 4 <br /> MAILING ADDRESS LAFe OT <br /> PROPERTY ADDRESS <br /> I VV��✓✓ (� <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECKR GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ J <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> c A <br /> STRUCTURE/ADDITION USE: )C I?h" c PLjCk <br /> (Home/Cabin; CommercialBusiness; edroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ^ N <br /> N r� <br /> O <br /> 3 � <br /> A PLOT PLAN MUST BE PROVIDED ON AN B 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. y- r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ok�l�C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. N _ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB) AND ALL NEW w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Ih. <br /> AND INDICATE NORTH (N). ;� z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 2. d <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 - IJ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. .r <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i^ y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE C)J g CJJ <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 WHENQ, ! ' <br /> NEEDED. Y It <br /> / <br /> THIS PERMIT I5 SUBJECT TO ALL CONDITIONS LISTED BELOW: v,� _ h n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z �I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. g N <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. w <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 2 ^g D ^.r1 r;G D57 b <br /> f Z 9 n 4 'z <br /> I declare that this application(including uding any accompanying schedule)has been examined by me and to the best of my g o � � a m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a =_ =o .j <br /> Information contained In this application(Induding any accompanying schedule)and I further declare that I recognize that this ! n o <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d E R c E i <br /> further accept all liability that may be a result of the County of Burnett retying on this Information I am providing In this o ' ;,,N;=({) 7 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ' o$ [" <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. ' m 8 H u n <br /> 3 '+f y88008 „>,� <br /> OWNER'S SIGNATURE �'4i 7��Q O = 19 '&- <br /> (date) <br /> 20NING ADMINISTRATOR <br /> w i 3 C) `n <br /> c n '.s1 <br /> cR. <br /> : � ti1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a ^ <br /> bP <br />