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n t Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ? ° <br /> APPLICATION FOR LAND USE PERMITS y r\ <br /> '^n <br /> OWNER 'AS A Y' ` e I 12.. TELEPHONECLQ/ _ $ 3w-9- <br /> -9— 81 Sd <br /> \0 <br /> MAILING ADDRESS •� 0,<j��, x C/ t� r <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> LO i 1 300 <br /> o% f-? 5 xi a . to ! C IJ t n! Lt.) 4 & C ! ) <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING F ADDITION ❑ DECK)V GARAGE/ACCESSORY STRUCTURE 9 m <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS C9 FILLING/GRADING 9 CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: AX6z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ' O� <br /> BUILDING CONTRACTOR. W.¢..r 'C.rt>~/ <br /> At4-n' fYlVLr K 0.m" r <br /> rharr lCa hvn�sa es <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS z0 0 <br /> WILL BE RETURNED. 2. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. W <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEWrr <br /> 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). J .o N Ui Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) O o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w 5 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. , p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 9J <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - N <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. y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN c° <br /> NEEDED. <br /> � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �' C <br /> �I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p N Z <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 — N <br /> SETBACK AREA. W <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. d <br /> 6 NOT TO BE USED FOR HUMAN HABITATION. d <br /> 7. 9 n n n 0 a c ro <br /> Eoo � aatn <br /> n 3 3 ❑ m <br /> H 3 3 3 <br /> [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 v E a 9 m `O <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .� a P $ a= - /tae <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this = '�N d, = H <br /> application. I agree to permit cWnty officials charged with administrating county ordinances or other authorized person to have �i"' <br /> access to the above-described pf$nises at an�j/regasonable time for the urpose of inspection. a o W N ti w <br /> �,. <br /> OWNER'S SIGNATURE a- /` �(,~L to <br /> A !'oi 6 6 0 0 0 0 0 i <br /> ` <br /> (hate) o wd�. � d oET2 <br /> I �y 5 " x a n. H 3 <br /> ZONING ADMINISTRATOR l� '7 �� ,_H �- " o S In <br /> TOWNSHIP PERMITS MAY BE REQUIRED A <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE '"N�' <br /> Wvy't, ++ 1(2+'Irvnat(.P-6 +-D J���lrs ImC U�rl��l� � � 00000 <br />