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z <br /> 3 f <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER /J TELEPHONE <br /> 65, <br /> jow.J�£ y 65._ <br /> -1 <br /> MAILING ADDRESS�p� /J'u,R T£R ST S•.TUL t�N. sS�� � 1 J <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION V <br /> S'z o< 5W �d of yNLL) k4 4� <br /> TYPE OF PERMINS): SINGLE-FAMILY DWELLING I7 ADDFTTO DECK❑ GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO ❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT 0 <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ - 3 <br /> STRUCTURE/ADDITION USE:_S�wk'e XfE; D20 b4 <br /> (Home/Cabin;Commercial Business Bedroom; Deck;etc.) L <br /> BUILDING CONTRACTOR: v <br /> S � <br /> zC <br /> A PLOT PUN MUST BE PROVIDED ON AN 8'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> M _ <br /> DIRECTIONS FOR PLOT PUN DRAWING: (ARIAL OR TOP VIEW) c _ <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 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J '� <br /> AND INDICATE NORTH(N). CCJJ Alm <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS) SU <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK L x, <br /> (OHWM)OF LAKE,STRUM OR RIVER AND WETUND AREAS,AND(D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1(r) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. C <br /> U ( <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'P-r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r�^YI% _ z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O Imo_ <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. J <br /> 6. <br /> 7. z > O .. n > U <br /> FB 223 " z <br /> zs: n 3 ; S � � � <br /> Ideclam 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 Ne detail and accuracy of all _ o" <br /> Information contained In this application(including any accompanying schedule)and l further dedam that I recognize that this _ o > cc ' n <br /> information I am providing will be relied upon by Me 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 I am providing in this <br /> application. lagreeM permit coon oficials cChaarrwged wiM administ,sbag county ordinances or other authorized Person to <br /> have access to the above-de premise;,a reasonable time For purpose of inspection. 9 <br /> OWNER'S SIGNATURE � � S- � / � n � ;• R $ o � _ - <br /> (date) C <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />