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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a P <br /> APPLICATION FOR LAND USE PERMITS N H <br /> o <br /> n <br /> OWNER TELEPHONE <br /> ''1J .i �_F _ fit = <br /> MAILING ADDRESS 991) !!!/3,/U Z/e 9011 ��tr o <br /> PROPERTY ADDRESS 2y V�J <br /> Cv // <br /> n � <br /> LEGAL DESCRIPTION r <br /> 0 <br /> TYPE OF PERMIT(5): SINGLE-FAMILY DWELLING ❑ ADDITION CI DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> V`ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL AD`DDIITION/❑/ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: .SfO rG�2. L.�I/I.IIU.�/)Ci' C'o <br /> (Home/Cabin; Commercial Business; Bed m; Deck; etc.) <br /> BUILDING CONTRACTOR: �� / L✓ n (' c" <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. .� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) rM <br /> c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, c <br /> AND INDICATE NORTH (N). ' N „� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)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 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. ) <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 f. o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (moi <br /> NEEDED. ~ (l w <br /> � Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z [^j <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. z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER Q) <br /> SETBACK AREA. /- <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. 9 0 0 0 N 6 O ts9 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all A mE r <br /> Information contained In this application(Including any accompanying schedule)and I further declare that[recognize that this c_ a 9 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I n $ <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 1 am providing in this <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 preml s t any rea nable time for the purpose of Inspection. <br /> m w n o W U <br /> OWNER'S SIGNATURE <br /> ry ce a :.. m � F -F, <br /> (date) � & � �. � �f <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED O °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE " <br /> O� 00000 <br /> fie, I� 16-Wr PjCIlecJ u/0 �67<3A <br />