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Burnett County 7416 CountV,,Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> 0. <br /> OWNER TELEPHONE p <br /> MAILING ADDRESS jyS7 9 <br /> 2.57!9 ,SWAT-D y o/i-KSS- L-4AjF_ <br /> PROPERTY ADDRESS s./oeE� w i .3--71972— . nCn <br /> °< <br /> L J1 (� r � <br /> LEGAL DESCRIPTION ) s S <br /> TYPE OFPERMIT(s): SINGLE-FAMILY DWELLINGN ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 ,2 <br /> W CA <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION <br /> 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE:.57 <br /> (Home/Cabin;Commercial Business; B room; Deck;etc. <br /> BUILDING CONTRACTOR: _) L)r" <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o N <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M tv <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o <br /> n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW �: w <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). o o <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 w C <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. C7 Q <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES or <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <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 I(N <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. NI <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN Iy W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 01 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z C <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. i? <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p <br /> SETBACK AREA. )i <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. C, <br /> 0 <br /> NOT TO BE USED FOR HUMAN HABITATION. a <br /> 6. <br /> T > 0 0 0 N a d <br /> 7. A n R 3 B 3 d = <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge 3 <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information A D a m <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I .o CM— : : <br /> am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit I further accept all S P-M Z <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree to § Fn:n <br /> �N n <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- 8 'Z 8 8 H 8 g <br /> described premises at any reason ble t1 for the purpose of inspection. ,�, 8 g N g o <br /> > C C <br /> OWNER'S SIGNATURE <br /> �-) <br /> ZONING ADMINI TOR a �N ' .° 0 o n <br /> w' <br /> TOWNSHIP PERMITS MAY BE REQUIRED C <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �el�rri r} d- 1 e f Vii_pt C,4eo(LApbL, KenrWj% <br /> cee�� s � Us000s <br />