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w � Z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator a y h <br /> APPLICATION FOR LAND USE PERMITS vy�\ <br /> OWNERAssit+ t `Ba R TELEPHONE (— Z s • O <br /> MAILING ADDRES <br /> ✓L.a.F Ss07A > \ <br /> PROPERTY ADDRESS �I <br /> BO CowjO Q. Ls> 3 r <br /> 0 <br /> LEGAL DESCRIPTION <br /> Sr 5w� S&fi) 13 ^ A7 — -+ �' <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTUR <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ r D. <br /> ° Z � <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ ! , <br /> STRUCTURE/ADDITION USE: A Q ili:�4• W <br /> ome a m; ommercia usness; room; DeC ;etc.) <br /> n <br /> BUILDING CONTRACTOR: t; t C 12 c Axi;✓ <br /> O � <br /> � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o �° <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 po <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, �I m2, <br /> AND INDICATE NORTH(N). \ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) b- d <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES (LJ y 1 <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. vJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN _ <br /> NEEDED. O x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> O ^ Z <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. 4� <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 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> S � n � a o on+ y0 '9 <br /> 7. c F P7 <br /> Q Q. <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 $ 'c c c om—,= : y <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I ;� C1 d N : w o 'b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this o 't <br /> application. I agree to permit county officials charged with administratingcounty ordinances or other authorized °i D <br /> ty person to have m <br /> amass to the above-described pr s at any reasonable a for thex > <br /> purpose of inspection. � � � `.�° g g c <br /> OWNER'S SIGNATURE +I•• J`*•c� �B b /( n m y`� y f1 C7 ` ^n O <br /> (date) <br /> ZONING ADMINISTRATOR M <br /> TOWNSHIP PERMITS 14AY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE "N <br />