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C A p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Offlce of Zoning Administrator g <br /> APnPLICCATION FOR LAND USE PERMITS <br /> OWNER I C C TELEPHONE a <br /> G5ep f J C'1'F" <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS C �— <br /> J 0 <br /> LEGAL DESCRIPTION o < <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE J¢¢¢ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 , <br /> n <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c � <br /> STRUCTURE/ADDITION USE: LL A.J O o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) �- <br /> BUILDING CONTRACTOR: n <br /> 0 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o y <br /> WILL BE RETURNED. <br /> 6 <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 In b 3 <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). N c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w Q <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES W <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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 — c <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. `fel' 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ti lQN <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � C) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 0 Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. A Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <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. <br /> ao �yyC <br /> 7. n � n333q <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 F,'� R = ii?w' S <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of all fiNE, <br /> Information contained in this application(Including any accompanying schedule)and 1 further declare that 1 recognize that this ° NInformation I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I yi 'adfurther accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this o o "N: H o 00f. <br /> application. I agree to permit county officials cha ed with administrating county ordinances or other authorized person to have 8 8 8access to the above-described premises at y a nable a for the purpose of Inspection. m g 5, <br /> 3 n � > g o0 0 0$ y <br /> c n a o W m 'n - <br /> OWNER'S SIGNATURE _ (date) ° w > 3 'g 2 <br /> ZONING ADMINIST R J I�� L <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` d <br /> n <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE »= H»»a <br /> �ug000g <br /> or)ti k 4-1 � e rn C i be a men ow <br /> 9-jo—o6 <br />