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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS a <br /> /J I ( � = J <br /> OWNER -h�eewZIrjborn C7 <br /> l/ TELEPHONE <br /> MAILING ADDRESS I1/� / /„ �r �5��� �(�1 � �a/LpU✓� / I,� �y�(J }'� � VI <br /> PROPERTY ADDRESS C:q 7 f�ti� <br /> < -h <br /> LEGAL DESCRIPTION ()� (� 0 <rn Ve <br /> TYPE OFPERMrr(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ D C GARAGE/ACCESSORY STRUCTURE ❑ -F m <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL ING CQM KAL ADDITION <br /> . COMMER AL ACCESSORY STRUCTURE O <br /> STRUCTURE/ADDITION USE /UJ4eS .-I o np � <br /> Z ¢� <br /> (Home/Cabin; Comrh&cial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Lail <br /> O � W <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rk X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. kA <br /> = <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) rnn <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, a <br /> AND INDICATE NORTH (N). v Z <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 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. I p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES Y <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. I 1 <br /> 5. 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. 70 t`G Z3 9) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r <br /> NEEDED. <br /> Jl O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �' n W <br /> In <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. Z G <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 Q <br /> SETBACK AREA. (fl <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. F <br /> 7. > o 0 0 0 a O b <br /> I declare 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 a d d- d <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this __. > > m `O <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I a A a aa' eye <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this NEW: <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ';� o o � <br /> access to the above-described premises at any reasonable time for the pyrpAe of Inspection. a o w <br /> X S l r I LJZ I[�7 Zvi �e > > c `� <br /> OWNER'S SIGNATU <br /> (date) S' nRE <br /> o a 3 np _ <br /> _ <br /> ZONING ADMINISTRATOR <br /> t-1 <br /> TOWNSHIP <br /> TOWNSHIP PER ITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N o U o <br /> 00000 <br />