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Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> MAILING ADDRESS <br /> //// IV <br /> iV J I . <br /> PROPERTY ADDRESS ���� <br /> Nc SANE /)ar06u rz, �J,' 3 yy3 d <br /> ,p / y <br /> LEGAL DESCRIPTION SSI- LQVM; f)• n SO/CI//, e�p/A <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION '❑j/DECK ❑ GA GE/ACCESSORY STRUCTUR (l <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS III FILLING/GRADING IT CAMPING UNIT❑ <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE 0 3 <br /> STRUCTURE/ADDITION USE: �RAE6 t:JT,PAFiF- - z 1- <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) IBJ G,5 <br /> BUILDING CONTRACTOR: I�ILy-w <br /> A <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. „1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EKISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW O V' c <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, V L(1 <br /> AND INDICATE NORTH(N). <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 MEASUREMLNT(S)TO THE ORDINARY HIGH WATER MARK "' 1•�. <br /> -(OHWM)OF LAKE;STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT-DIMENSIONS:- <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 /> S. 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 UI s <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 <br /> - d <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r� n <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. <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 /> 2 A > rinnc > <br /> - s <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0•j ,�^, _ _ - 5 1 <br /> knowledge and belief it is true,carnet[and complete. I acknowledge that I am responsible for Me derail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and l further declare that l recognize that this = 5 o> c_ N D <br /> information lam providing wiHbe re lie du by the County of Burnett Wisconsin in determining whether to issue a permit I S - <br /> FurtheracceptallliabilityMatmaybeare [af[he Cauntyaf Burnett relying in(armd[ion lam providing in this ¢= q v � <br /> application. l agree to permit county o ials charged with administrating county ordinances or other authorized person to ^ � ' <br /> have access to the storm-descH(e amiresatan the purpose ofinspeRionMOCT , <br /> r > ' w ('� <br /> /�b > <br /> OWNER'S SIGNATURE fe! 'r A <br /> (dotaZONING ADMINISTRATOR _ ^. m <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNEIT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEZONING = <br />