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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P <br /> APPLICATION FOR LAND USE PERMITS y w <br /> OWNER( / / E ,// [.t// TELEPHONE W <br /> MAILING ADDRESS r -n� 0�� `1 <br /> vim✓ O(O f 7 /��f(/ el4xD;A /"�// <br /> PROPERTY ADDRESS aD4-S ��i�-tE ,e 4D ' <br /> n <br /> LEGAL DESCRIPTION C'OT 4 OF C5m Vdlume, /S- P46-6 3S o <br /> N 5tct(oW / 7�flNi2/ ►Al Towu cFWEBBtAKE <br /> TYPE OF PERMIT(S); SINGLE-FAMILY DWELLING ADDITION O DECK O GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMM AL B ILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE E] .°r. <br /> STRUCTURE, OWL <br /> ! _E o <br /> (Home/Cabin; Commercial Busin s; Bedroom; Deck; etc.) CT7T2. T� <br /> BUILDING CONTRACTOR: s O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o . <br /> WILL BE RETURNED. C G 0 2. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c 1 PC <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) a `� <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S' ..� <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. S rn J <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C <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. <br /> N ^�• `,�' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS9) <br /> .OF PERMIT. � n � r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. h <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER r o j rt <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. f <br /> 7. „ gp agngnnOappro <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 <br /> Information I am providing will be relled upon by the County of eumett Wisconsin In determining whether to Issue a pe that <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this " �5.9 > m`O <br /> I c o a w Y <br /> further accept all liability that may be a result of the County of Bumett relying on this Information I am providing In this q 'o e ;,,;,, w N 'roC <br /> application. I agree to permit county officials charged with Administrating county ordinances or other authorized person to have g e .r. <br /> axes to the above-de remises ny reasonable a for a purpose of Inspection. o <br /> p m yA G 0 W O <br /> OWNER'S SIGNATU a-S — � n <br /> (date) o ce g a m m m <br /> ZONING ADMINISTRATOR �-/G/�7 ` C r l eia{1 � �: <br /> GL <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> c: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Perm;� l lei ry a�c`Ger a �Gv/a - -a g �188888 <br /> y <br />