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z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator 7 0 <br /> APPLICATION FOR LAND USE PERMITS rt <br /> OWNER (.J TELEPHONEr _ ry��_3/ �� a 41 <br /> AjO <br /> MAILING ADDRESS <br /> 54 212 BSS L C70OD AJaSrQ MAl 03 ; <br /> PROPERTY ADDRESSa <br /> 5_ C7 <br /> LEGAL DESCRIPTION JA1 9 <br /> 0/2 Tow,u cc fAcic532 T o r2i w Sw /ZS <br /> y <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING C] ADDITION DECK❑ GARAGE/ACCESSORY STRUCTURE'AI <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ ♦- <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S <br /> z <br /> STRUCTURE/ADDITION USE: o <br /> ome in; ommeroaBusiness; a room; Deck;etc.) <br /> BUILDING CONTRACTOR: S F n <br /> �. <br /> A � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLPL <br /> WILL BE RETURNED. <br /> ETE OR ILLEGIBLE PLOT ANS <br /> a <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. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW p `� <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, 3 <br /> AND INDICATE NORTH(N). 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 MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK p O <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 11 H <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE '� E <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 /> NEEDED. 1 l'It <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: YJ <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. C� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER C, <br /> SETBACK AREA. v) <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p <br /> NOT TO BE USED FOR HUMAN HABITATION. p <br /> 6. D <br /> 7. � � hDc o o C1 ab 't1 <br /> a n n 3 3 3 a 4 a Cz1 <br /> x 333 = c. � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all 'v d a : y <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this E. S a m `° <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ? a E:= > <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this m ` ' v, `C <br /> application. I agree to permit county officials charged with administrate00 <br /> g county ordinances or other authorized person to C1 '' c g ? r' <br /> have access to the above-descri ed p ses at any reasonable time fey the purpose of Inspection. o v y <br /> 7 <br /> OWNER'S SIGNATURE / �3 /it 'zf ,, r g $o g '3 y <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 <br />