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v Z <br /> ° � o <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER �J a __TELEPHONE6 _')IaO <br /> MAILING ADDRESS 7s �Gn a) K� lob <br /> PROPERTY ADDRESS J c \ <br /> LEGAL DESCRIPTION Nl& 13 4 L4 nsm V ' c, Itsq 6 4 -sa, 3 'm4-ol 1 1-I; � ,1 ° <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK O GA IRAGE/ACCESSORY STRRU 'CTVURIEE X�ti <br /> BUNKHOUSELI 59.692(1V)GAZEBO O STAIRS O FILLING/GRADING O CAMPING UNIT O <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURED <br /> STRUCTURE/ADDITION USE: m-P �' �;( (J r}(cYil�- s <br /> (Home/Cabin; ommercial ness; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> 5) <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS h <br /> WILL BE RETURNED. _ <br /> f1 a <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � m <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 <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, -9 9 <br /> AND INDICATE NORTH(N). c U7 z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) '�° <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. <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. 6` j 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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> 1 r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. I n 2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O 7' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. J <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER d <br /> SETBACK AREA. G <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. C <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. ����a�- �#g �� T > n nn C) > 0 ^U <br /> gn ,^o333 � a � m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my ,� <br /> o <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all El El :2 <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this E. > m N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m a a w'" D <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit my officials charged with administrating county ordinances or other authorized person to n <br /> have access to the above-de rib premi s any sonab time for the purpose of inspection. 8 E > i g,�w n <br /> > <br /> OWNER'S SIGNATURE - �(�—a� -�'� 3 rt <br /> A ° <br /> (date) <br /> o zn a Q m c� d � OZ <br /> ZONING ADMINISTRATOR <br /> o cw i � OCi7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED y <br /> o ao <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O <br /> fA� N�69� Q <br />