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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER0 <br /> TELEPHONE <br /> John �-Im-,i I ton <br /> o <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS /.5-3P�-e(�,. J _ / ;�e (nom ! J <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION O DECK ❑ GARAGE/ACCESSORY STRUCTURE .. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMME//R�C��I��AL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: � Q.'.'K- o 'Y <br /> (Home/Cabin: Co ercial Business; Bedroom; Deck; etc.) ` IP <br /> BUILDING CONTRACTOR: J <br /> n <br /> �n w <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. s <br /> n c <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, l <br /> AND INDICATENORTH (N). . z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O 'o T' - C> <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 11 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. o �, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. r <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 1�;' <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Q� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. W O <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. C <br /> 6. <br /> 7• T � > 000na0 �"0 <br /> n <br /> Fzon33 'c _. - 'F <br /> I dedare 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 c v d a .•] <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this c 5 o a m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I 5 N w' <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..I agree to permit county officialp charged with administrating county ordinances or other authorized person to have :. w <br /> access to the above-described praMlses a a y reasonabl a for the purpose of Inspection. w 6+ A <br /> OWNER'S SIGNATURE <br /> m Q H -C/ y C <br /> c H sa x <br /> ZONING ADMtNISTRA ' �� (G�Gth y vl <br /> Q <br /> TOWNSHIP PERMITS MAY BE REQUIRED A ( "° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> PCrm-4,i- ie-f-fr <br />