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3 Z <br /> Burnett County 7410 County Road K, No. 102, Siren,VII 54872 Office of Zoning Administrator _ <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERla <br /> o <br /> Jc F/-nTELEPHONE <br /> /.'. <br /> I � <br /> s <br /> MAILING ADDRESS Y3�/ ��SN A,e SJ 14ayr"/✓ /MLI, <br /> PROPERTY ADDRESS <br /> O <br /> LEGAL DescRlPnoN�p� can ✓y y./yP u, /'l� cors 78A hup /aSo r2.x S.O ZYoUY DWELLING L_ _ <br /> TYPE Of PERMIT(S): SINGLE-FAMILY DWENG 0 ADDITION 0 DECK GARAGE/ACCESSORY STRUCTUREAe "0 <br /> w -Q <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 7 <br /> 3 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL <br /> /FDITIAO/.N�❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: <br /> (Rome/Cabin; Comm dal Business Bedroom; Deck; etc.) <br />__.BUILDING CONTRACTOR: d�— - - - -- - - __ - - <br /> F < <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z%Il SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS ,✓, <br /> WILL BE RETURNED. =1 {I-- <br /> n <br /> m o <br /> DIRECTIONS FOR PLORED DIMENSIONS <br /> DRAIONS OR DI (A CES E SHOWVIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO!DUSTING <br /> SHOWN DRAWN SCALE. ` c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EKISTIN S BUILDINGS/STRUCTURESPORCHANDOTS (EB)AND ALL NEW q I <br /> BUILDINGS/STRUCTURES(NB);INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, SV � <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) �V <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(5)TO THE ORDINARY HIGH WATER MARK 1 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. 9.1 <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\L <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 WHEN Y I ill ly 1 <br /> NEEDED. <br /> VI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CJ F <br /> aj <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n � ILrn1y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 15 RESTRICTED ALONG SHORELINE. _ 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. _ 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> '-— <br /> SETBACK AREA. - <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. z ,q > r,nr,o > <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my o F. 3. <br /> knowledge and belief it is true,correct and complete. I acknowledge Nat l am responsible for the detail and accuracy of all a -{" A _ <br /> information contained in this application(including any accompanying schedule)and l further declare that l recognize Mat this _ g > c = <br /> information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I _ — <br /> furtheraccept all liability that may be aresult of the county of Burnett relying an this information t am Providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to + n <br /> have access to the above-describe s t any reasonable6/qe/{of the purpose of inspection. <br /> OWNER'S SIGNATURE / /� t7.eu-«"— a <br /> (dace) n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PfRMITS MAY BE REQUIRED I(�✓hp„'I,a ! - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />