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6 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <_: <br /> APPLICATION FOR LAND USE PERMITS <br /> V <br /> TELEPHONE <br /> OWNER G / 17 <br /> ( <br /> MAILING ADDRESS j Py, ,(/) V/'ew J)rl �) d <br /> ✓✓✓ 1 _ <br /> PROPERTY ADDRES , <br /> ) o <br /> LEGAL DESCRIPTION <br /> TYPE of PERMIT(S): SINGLE-PANIC DWELLING (' ADDIfIONNtiN D DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ 2. <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING CAMPING UNIT❑ <br /> o <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> z � <br /> STRUCTURE/ADDITION U4(�oCabin,'(', <br /> ommercial sin1enss; room; D f k� etc.) 1 <br /> BUILDING CONTRACTOR: Ulb VU �Q .n I <br /> N 1 c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS H <br /> c <br /> WILL BE RETURNED. <br /> � 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 O vC1\c <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J N i, L' <br /> AND INDICATE NORTH(N). 6 p� z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) UJ S. Y 9 <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. 9.J <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. QQj <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. J1 I r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN V <br /> NEEDED. IQI r d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: "I F <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. I 1 d <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. <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. <br /> 7. ' n °3 � 3 � d ! (rn <br /> h " 333 = = � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 ,� 7 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all y = m <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this 3 D Y <br /> information lam providing will be relied upon by the Countyof BurnettWisconsin in determining whether to issue a permit I p1 'e w V : .p <br /> further accept all liability that maybe a result of the County of Burnettrelying on this information lam providing in this s 4 : N: '=" �"', '9 <br /> application. I agree to permit county officials charged with administrating counhhtthV11tt�ordinances or other authorized person to <br /> have access to the above scribed prem: at an aeon time r the pue of inspection. <br /> AA,, ni <br /> 'z1 o00 00 _ <br /> OWNER'S SIGNATURE "W ( a� <br /> date) <br /> ZONING ADMINISTRATOR MAY 2 2012 <br /> IJ U <br /> �_/TOWNSHIF�`PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUCE ZIN� <br /> /CN <br /> 69 N 69(A U <br />