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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator = = IS <br /> APPLICATION FOR LAND USE PERMITS 9�) <br /> OWNER TELEPHONE U _� <br /> ✓ . 1 �sl- ySs—sSo / <br /> MAILING ADDRESS 13z � ��_ sd S,J !]... .I � AjzZ <br /> PROPERTY ADDRESS `�-� h <br /> LEGAL DESCRIPTION <br /> 7 <br /> TYPE OF PERMIT(5): SINGLE-FAMILY DWEWNi ADDITION ❑ DECK❑ GARAGFaACCESSORV STRUCTURE❑ = T <br /> BUNKHOUSE❑ 59.692(W)GAZEBO❑ STAIRS W FILLING/GRADING ❑ CAMPING UNIT❑ " <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> Std,rs <br /> STRUCNITI <br /> RFJADDON USE: L Ke P <br /> (Mame/Cabin; Commercial Business; Bedroom; Deck;etc.) V' <br /> BUILDING CONTRACTOR: <br /> O <br /> z <br /> A PLOT PUN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS r r� <br /> WILL BE RETURNED. r <br /> r <br /> DIRECTIONS FORPLOTPUN DRAIONS OR DI (AREAL O TOP VIEW) e <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 J <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (8)BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STRUM OR RIVER AND WETLAND AREAS,AND(0)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES I -_ <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 PUNS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE � <br /> PUNS MUST BE SIGNED AND DATED BY THE OWNER. i I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN �(nV u <br /> NEEDED. UI — / 1 'fes N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <br /> 3. NO GRADING OR SHOREUND 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 GARAGE/STORAGE ONLY. <br /> NO TO BE USED FOR HUMAN HABITATION. _ <br /> 6J%R43j, '� y7 b e �i /n /o 7`- <br /> 7. <br /> 7. „ .S > r, r; nC is z <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my c A <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all <br /> information contained in this application(including any accampanying schedule)and l further declare that l recognize that this = - <br /> information 1 am providing will be relied!upon by the County of Burnett Wisconsin in determining whether to Issue a Permit 1 <br /> further accept all liability that may be a result of the County of Burnett relying on this information l am providing in this <br /> application. Iagree to permit county officials charged with administrating county ordinances or other authorized Person to <br /> have access to theabove-described premises at any reasonable time for the purpose ofinspection. a rnT <br /> OWNER'S SIGNATURE���`-�✓Nc�i 7�2//3 _ <br /> c = o <br /> (date) <br /> ZONING ADMINISTRATORL�/'/Y'C �� <br /> ac ; <br /> TOWNSHIP PERMITS MAY BE REQUIRED '- '7 - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o <br />