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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS s. W <br /> OWNER TELEPHONE <br /> 6�..as-w►. Ze 9Sa- rerb4-3al <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> (0131 FiotrlAe�e DrilO� �vw. WC <br /> LEGAL DESCRIPTION <br /> c� 35 `t�NG❑ DDITI � 05-c�3-oHo��$3o a <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLIAO ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION//❑ COMMERCIAL ACCESSORY STRUCTURE❑ A <br /> STRUCTURE/ADDITION USE: Z~� Sjb"WW D!J b�aLlla�tt 1 I Z <br /> (Home/Cabin; Comma ial Business; Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> O <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW tysf w n <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, .. <br /> AND INDICATE NORTH(N). 19 c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) O <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK JC1NJ ,((Yw=> <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. �' y <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. _ I H <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THEF'(.._/Ij-\11j g <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. �� O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �j T <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 GARAGF/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. ^7g ,>, 00n > tbsJ <br /> I declare that this application(loduch p any acro psrykq schadas)has been emMned by me and to the best of my <br /> krio vledge and bale!B Is true,aorreot and complete. I aWpwledge that m gle 1 aresporMfor the dedX and amaecir of all <br /> Information contained N this apPRmtwn(Including any aocompa,ykp schedule)and I further declare that Irewgrdve <br /> IManatbn I am providing will be ragBurned:ed on by the County of Burned: in de0air <br /> m "whether to lane as the this <br /> hwUw accept all liability that may be a result or the County of Burned retylnp on this Information I an provam In this 3 d .0 <br /> application. I agree to per rrst county chagad with ad inishatkp county ordkanos or ntlws authorized person to have r' <br /> access to the above-defaced <br /> reasonable mna ror ma wapale N Inspection. ^.T ® $ A <br /> /' m 6 ag8 8 <br /> OWNER'S SIGNATU 7 Ip o��/o� & y w n <br /> (date) <br /> ZONING ADMINISTRATOR t' 6 TM <br /> M <br /> TOW SHIP PERM MAY BE REQUIRED ���� ' <br /> THIS PERMIT SHALL EXPIRE 06 YEAR FROM DATE OF ISSU <br /> i;e=8 <br /> APR 202 2 <br /> BURNETT COUNTY <br /> ZONING <br />