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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a � <br /> 0 <br /> APPLICATION FOR LAND USE PERMITS N y <br /> OWNER � �u �3,9N T LEPHONE <br /> 1 I? <br /> d <br /> MAILING ADDRESS 0, / 2-2/ 1 ( O <br /> PROPERTY ADDRESS <br /> 2-(,)L, Simi 5clL KP — <br /> 0 <br /> LEGAL DESCRIPTION <br /> TYPE of PERMrr(s): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑7 s' <br /> a <br /> STRUCTURE/ADDITION USE: 6�raP/ c <br /> (Home/Cabin;Com rcial Business; Bedroom; Deck; <br /> Qetc.�)/ <br /> BUILDING CONTRACTOR: 9S r�/s,40P <br /> S Y& 7 2 ? 1/ ` Z-ttit`-1 5(,(, -()o9q o v <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. C _ <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. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW m as 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a b <br /> AND INDICATE NORTH (N). l Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK w' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. OSu <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES h' - <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 PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE o <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 /> C—) <br /> NEEDED. SlJ <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ,z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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. F <br /> 7. 'm an a O .0 <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 <br /> Information contained In this application (including any accompanying schedule)and I further declare that I recognize that this f° S. y tb N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I v & a c^ Y <br /> further accept all liability that may a result of the County of Burnett relying on this information I am providing in this 5 5 w �, "d <br /> application. I agree to permit con ofFlclals charged with administrating county ordinances or other authorized person to Q k <br /> have access to the above-descrl d premi s t y asonable time for the purpose of Inspection. S D <br /> OWNER'S SIGNATURE y <br /> 3 m �' c g o 0 o y <br /> rt a o <br /> T (date) n n a m 'y z <br /> ZONING ADMINISTRATOR <br /> y�„ sOr�n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> o eo <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o <br /> t�9 � oNfn� o <br /> n o00 0 0 <br />