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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ r/ ) c (W <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERYr�^ „ � \ • LJGw TELEPHONE (D(a tl�3:/ _Il'/O� •� <br /> C�NN'lA T rT <br /> MAILING ADDRESS I W s <br /> 15183 uplc�u� S-F. IJw ,�vu ,u,LJ Ss 3')� <br /> PROPERTY ADDRESS Der,1,' <br /> e ^1,' <br /> LEGAL DESCRIPTION / 0 /- y Gw Vq S W 1/'( AeL 33 1 41 tj � �/ (,J <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE = n <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING ❑ CAMPING UNIT❑ � CY <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 3, <br /> STRUCTUREIADDITION USE: dt.IT til ��:� �r <br /> �r� <br /> (Home/Catlin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> z < <br /> AP LOT PLAN MUST BE PROVIDED ON AN 8'/s X11 STUFFY OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. T• %,\ F: <br /> M W <br /> DIRECTIONS FOR PLOT PUN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r rr 11 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW �� W c <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, V <br /> 1 <br /> AND INDICATE NORTH(N). Ca U I <br /> 3. SHOW DIMENSIONS IN FELT OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) IN ( P <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK - <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <br /> 9. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES ? , <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PUNNED AND SHOW AREAS TO BE GRADED OR FILLED. I -y,} -i Ir•}� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE /11 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Ii V`• �W?J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN v . <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: [� F <br /> I <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. If <br /> 9. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. (• <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 2 ,, b > nnnn >7. <br /> cr <br /> I declare that this application(Inclullingany accompanying schedule)has been examined by me and to the beat of my B e <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the uncalled me mcy of all y <br /> information contained in this application(including any accompanying schedule)and Ifurther declare that I recognize that His = > > a_ D <br /> information 1 am providing will be relied upon by the county of Burnett Wisconsin in determining whether to Issue a permit. I <br /> further accept all liability Mat may be a result of Fire county of Burnett relying on this information I am providing in this <br /> application. I agree to Permit <br /> m county officials a with administrating county ordinances or other authorised person to <br /> haw access to the above-0e ices at Y reasonable time for Me purpose of ins ? > : <br /> OWNER'S SIGNATURE ` - 3 n 3 w- '`�+ <br /> 9 A <br /> (d IWN <br /> nv, nz <br /> ZONING ADMINISTRATOR _ it 9. g ?n(9_ <br /> TOWNSHIP PERMITS MAY BE REQUIRED p�J a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF RS COUNTY A <br /> P(JNING <br />