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C O O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER— TELEPHONE <br /> nOPP PSC' It 'eL� 7/ s • Z3`( ' l33 / d � <br /> MAILING ADDRESS <br /> �a![c <br /> /rZ7 inner <br /> PROPERTY ADDRESS W <br /> 3,,/72 <br /> LEGAL DESCRIPTION lOt 3 C[S•/YZ <br /> L 9- <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARA E/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ y, <br /> Jl� <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ _S <br /> STRUCTURE/ADDfITION USE: — W <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: -S <br /> o � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o _ <br /> WILL BE RETURNED. <br /> .ar c <br /> � 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. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW Pf aha <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). N N I 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 UJ w W <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O <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. 2. <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 7� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I W <br /> NEEDED. <br /> THIS PERMIT IS SUBIECr TO ALL CONDITIONS LISTED BELOW: (r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER i <br /> SETBACK AREA. (Jtl <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> o 0 0 c9.C7 <br /> 7. sef0a o333nE� <br /> rr <br /> 2 0 2 0 0 0 : 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my g o ,� B R e ° � I <br /> knowledge and belief k M <br /> Is true,correct and complete. I acknowledge at I am responsible for the detail and aw racy of all a m F_ E. a <br /> Information contained In this application(Including any accompanying schedule)and I further declare Mat I recognize that this o e.> c m ti <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to lave a permit. I 2 <br /> further accept ail liability Mat may be a result of the County of Bumett relying on this Information I am providing In this <br /> application. I agree to permit county officials:charged with administrating county ordinances or other autlwrtred person to havec C <br /> access to the above-described premises at any reasonable time for the Purpose of Inspection. W a v,w N`� <br /> a <br /> OWNER'S SIGNATURE (7ff�1' D� (date)la o s5 a o'2d o <br /> ZONING ADMINISTRATOR VGIn Fla y 9 �, <br /> TOWNSHIP PERMITS MAY BE REQUIRED C' <br /> TH,IS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o o <br /> P_e(/ c -vle-h-frm�Ckd i-D PbyfTescAkr <br /> I <br />