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_ z <br /> o , <br /> Burnett County 7410 County Road K.No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS = <br /> ECi zh Bc N, Bccn7p- sf <br /> OWNER I ^ .�n ^i TELEPHONE /_ I� �a S S (Z 0 O <br /> MAILING ADDRESS Q` s <br /> SRak J� PLACc2 �i�}t, Y11/J S��l36 \ <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION (—CT <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING 0 ADDITION DECK 0 GARAGEIACCESSORY STRUCTURE 0 = V' <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 - <br /> STRUCTUREJADDITION USE: p"BCCOII /DON <br /> p,�., (Home1/1Cabin; Commeroal eu9ness_Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: IYICCpf' G'LyrN)ST. - <br /> z <br /> A PLOT PUN MUST BE PROVIDED ON AN 8'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> r <br /> 'DIRE. ALL FORPLOTPUN DRAWING: (ACES O ESHOWTOP VIEW) <br /> 1. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE =' - - <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, ZJ <br /> AND INDICATE NORTH(N). p <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)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. 91 .. ' <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(SI)AND DRAINFIELD(DF),AND ALL DISTANCES- I - 5— <br /> TO BUILDINGS, ROADS,LAKE, LOT <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 I'� <br /> PUNS MUST BE SIGNED AND DATED BY THE OWNER. VII r1V <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> y �I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> ` 2. REMOVAL OR CURING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — - <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 /> - <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> ]. ., X: > noon > cr <br /> F ' 3 - _ S <br /> I declare that this application(including any accompanying schedule)has Dean examined by me and M the best of my 3 ? 2 R a <br /> knowledge and belief it is true,correct and complete. I acknowledge that l am responsible for the derail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and l Further declare that l recognize that this _ - > Gti <br /> information l am providing will be relied upon by the County of Boman Wisconsin in determining whether M issue a permit I - <br /> furtheraccept all liability that may he a result of Me County of Burnett relying on this information l am providing in this _ m ' <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to = fir <br /> have access ththe abave-tlescrib//ed premises at any r sonable time for Me purpose of inspection. n > C. N,'^„ f'1 <br /> OWNER'S SIGNATURF� m - 3 - - <br /> VV cue) �1�pi _ k ^ <br /> ZONING ADMINISTRATOR r -1 <br /> JUN 4 2 - <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE BURNEIT <br /> ZONI <br />