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NI Z <br /> t /^ 5 <br /> Burnett County 7410 County Road K,f No. 102, Siren,WI 54872 Office of Zoning Administrator Vm) <br /> APPLICATION FOR LAND USE PERMITS <br /> 1 owl �h1 S c <br /> OWNERRTELEPHONE <br /> � <br /> f� /L / <br /> MAILING ADDRESS 4Y. <br /> PROPERTY ADDRESS q <br /> of7 J y 5 %, zAa C1q � ) <br /> LEGAL DESCRIPTION <br /> GE —N ' <br /> C —/ V <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE. 2 <br /> m <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ b <br /> r a <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> ` z <br /> STRUCTURE/ADDITION USE: 1� <br /> (Home/Cabin; Commercial Busin s; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: <br /> � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 r/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c <br /> WILL BE RETURNED. `D <br /> fi a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C, <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW g <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, N a <br /> AND INDICATE NORTH (N). O 0 Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) SU o <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. A.l <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. 6 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. III <br /> r W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. d Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 'A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (� <br /> SETBACK AREA. }1, <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. AoTd: /0 4r a (1>mcl E 6: eveairA <br /> � aao �d <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 X93 3 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all �, m m d rn : -3 <br /> information contained in this application(including any accompanying 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 of Burnett Wisconsin in determining whether to issue a permit. I o c ?oa v > <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this r N <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to <br /> have access to the above-describedyremises at any reasonable time for the purpose of inspection. c m > <br /> OWNER'S SIGNATU 7LgU T, Lu <br /> 6 0 <br /> �J (date) Dm n p _. 2 <br /> ZONING ADMINISTRATOR 2 A 6,1 ` . ,�T —ZO <br /> 12JUN Z IS <br /> c n [s9 <br /> I o o. rl1 <br /> TO SHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAaURNETT COU S <br /> ZONING ';l a <br /> 0 0 0 0 0 <br />