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W n Z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administratorg ° <br /> APPLICATION FOR LAND USE PERMITS y <br /> � C <br /> OWNERQ <br /> �O e yZ / L TELEPHONE <br /> MAILING ADDRESS <br /> /� //��00,1� LA/'✓t� S%2�/(„/IYJCA MN b 5. ./'��- v <br /> PROPERTY ADDRESS 7 7 1-1 <br /> ✓// Cr/ A /0j G. ,6 V <br /> ` <br /> flCi Xv� <br /> LEGAL DESCRIPTION �1 c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESsORY STRUCTURES' <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ 3 <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S' <br /> /v Q <br /> STRUCTURE/ADDITION USE: j�pS P c <br /> (Home/Cabin;Commercial§usiness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAI 4S Q ` o_ <br /> WILL BE RETURNED. <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ° <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. K d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EKISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW r�i1 w o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS; PORCHES AND OTHER STRUCTURES, El <br /> AND INDICATE NORTH(N). z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B)BUILDING(S) o ? <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. O �' <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. ti b <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE c <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 411 <br /> OG) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHE t3 <br /> NEEDED. I <br /> � O <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 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. w C7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. G A <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 TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7, er n o 0 o n c d <br /> A ^ B 3 a �. <br /> B <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of myknowledge 3 0 q a a. a_ $ F, w' <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I v c D D m N <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept al <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- w o 0 <br /> described premises at any reasonable time r t e purpose of inspection. <br /> � a <br /> y <br /> oIZ.-f OWNER'S SIGNATURE 7R <br /> �•Tn Vi Y F. t7 <br /> (date) 0 a N oo S <br /> ZONING ADMINISTRATOR {) a/lam.a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> f)k'fh t � -4- 1eo*1- Ana fled +v 6r j Voe tz <br />