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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator Z �) <br /> APPLICATION FOR LAND USE PERMITS — <br /> ( 6 <br /> OWNER <br /> Mt)ib-\� �OQ TELEPHO E _ _ 36�f7 <br /> (p O <br /> MAILING ADDRESS 'n, 1 m <br /> PROPERTY ADDRESS <br /> s _ <br /> LEGAL DESCRIPTION /I (j <br /> CAm <br /> TYPE OF PERMIT(S): SINGLE-FAMILY D ELLINGADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ ,a <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: IO� \ C `�''� V' ' <br /> ome a in; ommeroa Business; Bedroom; eC ; e . RJ - <br /> BUILDING CONTRACTOR: `� <br /> � o J <br /> O J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS ^ — <br /> WILL BE RETURNED. �' c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C O \ <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 O o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J a <br /> AND INDICATE NORTH(N). o' R-) Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) (,U <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. ' J <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Ski o <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. C r�l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. `fl <br /> THIS PERMIT IS SUB]ECT TO ALL CONDITIONS LISTED BELOW: <br /> d c' <br /> 14 n $ <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. 0 <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. Q <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. (Al <br /> NOT TO BE USED FOR HUMAN HABITATION. 8, f <br /> 6. d <br /> 7, 0D0 0 o Oa0 '9 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my o < ? w <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all g, y > EL EL a ; y <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I n °: n <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this v E^ 't <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to n d. : o : 8 <br /> have access to the above-described premises at any reasonable time for the purpose of inspection. °m ? sq v�N <br /> OWNER'S SIGNATURE A g$ o $ $ <br /> (date) n rsprn11 t�D'2 mgg f] rn•-*f, <br /> ZONING ADMINISTRATORK7 <br /> ? Jo. OEi o n � <br /> c <br /> m ❑ : jr c <br /> WNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Peer i.4 Ie Fes, prc7cQd y ala'{� y �! n $ 000 <br /> C0- ONs� � �11. _IISII J NNn� o <br /> U <br />