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3 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator = = <br /> IJ I'� /APPLICATION FOR LAND USE PERMITSpo <br /> - rt <br /> OWNER-BU rn 1,"f�/I -i7da TELEPHONE 115—,3) q—,gi5 ' <br /> MAILING ADDRESS O <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION DL <br /> ESC D I ns;m ✓ (o P)83 SPC-t;a,-) as T-gDnj R)-7y) <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGEIACCESSORY STRUCEuRE <br /> a <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO ❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ O _ <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED ' I <br /> 5TRUCTURE/ADDITION USE: VI <br /> (Home/ bin; Commercial Business, Bedroom; Dec$,;etc.) <br /> BUILDING CONTRACTOR: v �- <br /> z <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PUNS C 2 <br /> WILL BE RETURNED. "T <br /> r <br /> DIRECTIONSFOR PUN (ATOP <br /> ALLc <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCESCES TOO BE SHOWN OR <br /> S/ DRAWN TO SCALE. r — <br /> 2. SHOW THE LOCATION AND SIZE OF ALL G DECKS, <br /> BUILDINGS/STRUCTURE$(EB)AND ALL NEW !' <br /> AND INDICATE <br /> NORTH ( (NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, �l = <br /> AND INDICATE NORTH(N). pc <br /> 3. SHOW DIMENSIONSBILINFIN FEET OF THE FOLLOWING: (A)BUILDING(S)THE TO ALL LOT LINES,(B)BUILDING(S) (O�, <br /> TO CENTERLINE , ROAD,(C) BUILDING WETLAND AREA ,A THE ORDINARY HIGH WATER MARK l = <br /> (OHW T OF IANE,STREAM OR RIVER AND W TIC TA AREAS,AND(D)LOT DIMENSIONS. Ste} <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK($T)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. m <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PUNNED AND SHOW AREAS TO BE GRADED OR FlLLED, 6 <br /> 6. IF SEPARATE PIANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC,THE <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. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ; <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, EEC.,ALLOWED WITHIN THE REQUIRED WATER V <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. � L 'r�L�11�� IlJlq <br /> R n 2 2 3 ? <br /> 8 3 3 rt Z <br /> I declare knowledge and is appli ianon(indreing any t and coc plate. Ying cknowled e)ge hat I am ezami sib efori the d ta[M1 nd ac ura y 0 2 <br /> irmatioand belief Tin this ,correctn(icludinge. yaccompa yang sctl ule)andI fulefortM1etletail tIressi of all _ <br /> Information I am provnediding <br /> in this as <br /> (including county of Burnett <br /> Wisconsin <br /> ilco e)and I furtherin ng whe Nrt o issue a e that this 1 _ <br /> information lam proility t will a the a result <br /> by ofthec untyoff Burnettelying on <br /> thi information <br /> otor determining whether providing <br /> iapermit. I _ <br /> applica accept aneeEo Permit maytyo result charged <br /> withateurneratingount thisidinances oonlarauthoriing perso _ m' 56�.— <br /> application. lagree[o permitmunryaKcialz cM1argetl wiM administrating county ordinances or other authorized!person to < 3c <br /> have access to One atwve 'ted premises aea eason Ifitime for the purpose arin•V���/M 3 > ' �'un <br /> OWNER'S SIGNATURE 3 m `_ 8 o <br /> (data) C <br /> ZONING ADMINISTRATOR <br /> OWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g <br />