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= O O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS N N <br /> OWNER <br /> TELEPHONECF. nu O <br /> `hJ <br /> MAILING ADDRESS c� � j� 1 lr <br /> ISa� I/ ��� t� / l\ Iver F11ik 'W5y0 41-- <br /> PROPERTY ADDRESS 9-) <br /> � U} <br /> LEGAL DESCRIPTION IE- U (?-,s rn I ' -Y <br /> Wo <br /> TE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE C SORY STRUUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS 0 FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDINGc�❑ <br /> COMMERCIAL ADDITI�/jN ❑ COMMERCIAL ACCESSORY STRUCTURE ClSTRUCTURE/ADDITION USE: J+02a- e -UIJ / c__Pa' z <br /> 0 <br /> (Home/Cabin; Ci1immercial Busin ss; Bedro ; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n <br /> � U <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. y <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 m 'O <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, /� a <br /> AND INDICATE NORTH (N). � Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(5) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5. <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p o <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. O <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 G �I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1WN <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. _ W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ' O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '0 p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER i <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 /> 7. z >a o o Q>> 0 b <br /> I declare that this application(including an accompanying 2 1D g <br /> pp ( g y panying schedule)has been examined by me and to the best of my 3 0 � � 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 v' d2, <br /> a y <br /> Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this E. a a m " <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <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 county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. c ;3 m ;,, A w r1 <br /> 3 'i7 m > � o 000 y-7 <br /> OWNER'S SIGNATURE <br /> > �. mr� ,„ m0 <br /> (date) o <br /> ZONING ADMINISTRATOR 11 I I.0-Y I `� °_ y w' c c) rn <br /> ; GH %� c darn <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> � � 00000 <br />