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V Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS G' <br /> OWNER TELEPHONE o o,�( �- .Jer✓.�lvl � <br /> _ o <br /> MAILING ADDRESS IVeL-,,, 4 f C{ k"o-i cn <br /> PROPERTY ADDRESS p <br /> J /✓ J �C 111 < I <br /> LEGAL DESCRIPTION r' 1 <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING ❑ ADDITION G DECK G GARAGE/ACCESSORY STRUCTURE Ot w 5 <br /> BUNKHOUSE G 59.692(1V)GAZEBO G STAIRS G FILLING/GRADING G CAMPING UNIT G W <br /> 9 <br /> COMMERCIAL BUILDING G COMMERCIAL ADDITION G COMMERCIAL ACCESSORY STRUCTURE G <br /> STRUCTURE/ADDITION USE: fO A 'C �j c Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: IJe/✓ rC.k Co* i ctipi e !� <br /> n <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. •n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tni p <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 3 <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, El <br /> AND INDICATE NORTH (N). N o <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 R. <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O C_JCII <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES q <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m , <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. W <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 W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z p <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 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. <br /> 7. ^ fig 9 n n n Ci 9UV <br /> 6 <br /> N <br /> Fza3noo� <br /> I declare that this application(Including any accompanying schedule)has been examined by me and M the best of my B � �0 ,2 R ?w <br /> knowledge and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and amracy of all ^ m 'm-m a y <br /> Information contained In this application(Including any accompanying schedule)and 1 further declare that I recognize that this =_.a a m N - <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 1 am providing In this cIn o Cro" <br /> application. I agree to permit county officals charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any wnable time for the uricase of inspection. ° S -w p;N, n <br /> m w nowwo "' <br /> gS Q o 0 0 o S rj <br /> OWNER'S SIGNATURE <br /> (date) <br /> as <br /> ZONING ADMINISTRATOR " H <br /> o - <br /> TOWNSHIP PERMITS MAY BE REQUIRED G °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE A N <br /> Pee / ole' d io Cor)a <br />