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y z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PERMITS N <br /> OWNER IJCI�5 TELEPHONE 612 799 _ 6 <br /> fi c d <br /> MAILING ADDRESS Z,M FARk(�JWMa CWLE RC)SBOLLe- <br /> PROPERTY ADDRESS 7qZ ( , P—K ST b &JAV W-4: 542)3;D o <br /> LEGAL DESCRIPTION �+ �nc..�f'�.�cc Ltl( OF <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK GARAGE/ACCESSORY STRUCTURE ❑ -� <br /> BUNKHOUSE 0 59.692(1V)GAZEBO D STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> 4r ,a <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION D COMMERCIAL ACCESSORY STRUCTURED <br /> STRUCTURE/ADDITION USE: sj') c <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: -C <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o „ <br /> WILL BE RETURNED. <br /> l Ci <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m p <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 oo <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) a o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w5 J r� <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND GRAINFIELD (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. <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. O <br /> Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN a .� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r c) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <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, ETC., ALLOWED WITHIN THE REQUIRED WATER �. <br /> SETBACK AREA. 6_ <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. O <br /> 7. 77 > aoro <br /> yy g O O N 6 E= <br /> nvJ`. G O R <br /> [declare that this application(Including any accompanying schedule)has been examined by me and to the best of my g o ,2R <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 contained in this application(Including any accompanying schedule)and I further declare that I recognize that this > > o N Y <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 .°e �- P w< ! ! 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 c_ T'`_^N b <br /> application. I agree to permit county officials charged wi dIw istrating county ordinances or other authorized person to have `° o o r <br /> access to the above-descri t-eny easona a me r th purpose of Inspection. <br /> > y <br /> OWNER'S SIGNATURW p 2+ <br /> (date) <br /> f � z > ' E; <br /> �m F �a� <br /> ZONING ADMINISTRATOR O' N °_° H n <br /> TOWNSHIP PERMITS MAY BE REQUIRED d <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o N <br />