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yI <br /> Z z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator 7 <br /> APPLICATION FOR LAND USE PERMITS a o <br /> OWNER ��✓� // "L�/1 TELEPHONE/S—,S�.-—7�1. <br /> \e / O <br /> MAILING ADDRESSSVO, <br /> PROPERTY ADDRESS <br /> / hhln3do/w <br /> LEGAL DESCRIPTION <br /> v, <br /> TYPE OF PERMI7(5): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ 2. " <br /> STRUCTURE/ADDITION USE: S�Ti✓ W� W <br /> ome a n;Commercial business; room; eC ;etc.) <br /> �1 <br /> (/ 1 <br /> BUILDING CONTRACTOR: .Z lGl-N 11/ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 r/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS r <br /> WILL BE RETURNED, a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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, d a <br /> AND INDICATE NORTH(N). p p <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 O a <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND 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. L <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Z <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE 7 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. LN <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN f I y <br /> NEEDED. n <br /> THIS PERMIT IS SU83ECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. b n Z C Gp <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <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 A r„ <br /> SETBACK AREA. 0 v <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> 7yany ao -0 <br /> xzo ' a � go �. 'z <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 ,2 P, �1 = ? <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 actom 'ng schedule)and I further declare that I recognize that this °. D m N <br /> Information I am providing will be relied upon by the County rnett Wisconsin in determining whether to Issue a permit. I I - c oo= 7 <br /> further accept all liability that may be a result of the Co f urnett relying on this information I am providing in this <br /> application. I agree to permit county officials c h a inistrating county or or other authorized person to <br /> have access to the above-described premi n e time fort e p rpose of inspection. °m > g W N W A <br /> w 9 <br /> neo- n g8o88 � <br /> OWNER'S SIGNATURE <br /> (date) vi D'2 tv n p Z <br /> n : c <br /> ZONING ADMINISTRATOR <br /> w <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g <br /> p i-im `f le f e(�Picl�d t4 to 10L// <br /> � � 8000 � <br />