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b Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS Z <br /> e <br /> OWNER TELEPHONE <br /> /n4RK A VA-7\1CC /rAAY K VfiNc� bs1 - '{e2 • v9L2-- o <br /> MAILING ADDRESS <br /> lu b8 S&R e,JF c' SIuREyiEIA/ rMA1 SS/zG <br /> PROPERTY ADDRESS 2- 95 ,I c' GR A t4 r$&AkY e-A/1 r— C <br /> 1 T 7 c. 0 <br /> LEGAL DESCRIPTION I SKY L0 1 o 4.4. <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> b <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o � <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> IN <br /> BUILDING CONTRACTOR: 5.FL P O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O o_ <br /> WILL BE RETURNED. <br /> 6 �J <br /> DIRECTIONS FOR PLOT PLAN DRAWING (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. K <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m 9 3 pj <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). SO Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 9 -� <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. p Q <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES rAJ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. v, ! <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 U) <br /> NOTE: <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. " I o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: S �' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n CjJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B Z C1 C7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. F J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER r� <br /> SETBACK AREA. 1- <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. T n o 0 o h' t> 0 -0 <br /> $ n m333hPax <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my o,°2 q q S ? w' <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m E w_ EL <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this `: D a m N <br /> information I am providing will be relied upon by Mve County of Burnett Wisconsin in determining whether to Issue a permit. I a 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am provlding In this c <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at y reasonable time for Mce purpose of Inspection. 6 5 5 ro <br /> 0 r1 <br /> c a e o 0 <br /> OWNER'S SIGNATUREK rD > o o ~ <br /> / / /O () � am � p � � 0 <br /> (date) <br /> ZONING ADMINISTRATOR f'I l� 6� Gd <br /> TOW HIP PERM MAY BE REQUIRED <br /> THIS PERMIT SHAL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ul 22 N w a <br /> U� 80008 <br />