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— z � <br /> a <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 CG/,/ <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS Hyl LL" 1 G✓ ��_A � S n <br /> ial) n1,741) <br /> LEGAL DESCRIPTION '/ c <br /> s�Y4 5K 3� 1 <br /> TYPE OF PERMIT(S); SINGLE-FA IL DWELL ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCfUR J <br /> BUNKHOUSE❑ 69.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING❑ CAMPING UNIT❑ G <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURFJADDIITON USE: <:c4' 4le T'I J✓}60 11�1(O,�lQ,.�' y <br /> y-IH (Home/Cabin; COm1mercial Business; Bedroom; Deck;etc.) �R <br /> BUILDING CONTRACTOR: I�Fi�`i �(7 bt'lrr-ILYIUr T 3ccUU 1�1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 1 <br /> WILL BE RETURNED. <br /> n <br /> m o <br /> DIRECTIONSALLFORPLOTPUN IONSORDRAWING: (AN ES O ESHOWTOP O �- c In <br /> 1. ALL REQUIRED DIMENSIONS OR OF ALL EXISTING <br /> TO BE SHOWN S/ DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EKISEMG BUILDINGS/STRUCTURES(EB)AND ALL NEW T d m n R <br /> BUILDINGSI (NB), INCLUDING DECKS,PORCHES AND STRUCTURES,HER STRUCTURES, <br /> AND INDICATE ATE NORTH <br /> (N). W j <br /> 3. SHOW DIMENSIONS IN FEET ) THE FOLLOWING: (A)BUILDING(S)THE TO ALL LOT LINES,(B)BUILDING(S) <br /> TO CENTERLINE , ROAD, OR BUILDING WETLAND AREA ,A THE ORDINARY HIGH WATERMARK 1� o <br /> (OHWM)OF TAKE, STREAM OR WELL <br /> AND WETLAND AREAS,AND(D)LOT DIMENSIONS. - <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(Sr)AND DRAINFIELD(DF),AND ALL DISTANCES �- <br /> TO BUILDINGS,ROADS, LAKE, LOT LINES. , I <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED RA FILLED. <br /> 6. IT SEPARATE PLANS ARE SUBMITTED BY AN OWNER.CT,ENGINEER, BUILDER,CONTRACTOR,ETC,THE <br /> PIANS MUST BE SIGNED AND GATED BY THE OWNER. � •( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN J <br /> NEEDED. C� E <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. a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC1 ALLOWED WITHIN THE REQUIRED WATER <br /> —,----SEI-SACK-AREA. <br /> ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TODBE USED FOR HUMAN HABITATION. / F <br /> z > n n n c >ij s <br /> 's 3 3 <br /> I declare that MIS a application(including an accompanying a <br /> pp ( 9 Y ponying nMeedge has been responsible <br /> ib by r t and m Me bort u my 3 <br /> knowledge andbelie}iiIstrue,mired and complete. I acknowledge Mate ul )andifurt Tor scare and atturaq of all <br /> information contained in this applicetion(indWin9 any accompanYinq schedule)and IfortM1erdedare Mat I recognize Mat this = > > eN i <br /> informationI am Providing will be relied upon by the County of Burner Wisconsin in determining whether M issue a Permit. I <br /> further accept all liability Mat may be a result of Me county of Burnett relying an this information I am pmviding in this _ ��'+ '^v S <br /> application. I agree to Permit county officials charged with administrating county ordinances or other authorized person to <br /> haaccess M Me abavedescHbed mmi ny rOymua le time for Me purpose of inspection. H r u !7 <br /> = gog � > <br /> OWNER'S SIGNATURE ' �1�� - - <br /> (date) � s' aq <br /> ZONING ADMINISTRATOR c Fv : nq rsl <br /> �G cm ne'1 R1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED i C rt <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 3 <br />