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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 <br /> /� <br /> OWNER � 7�3- Ly�..gdwsSiz a 0. � <br /> sq��t� • `s`,tffvrtN( TELEPHONEC �ll, fsi,l�i5,5Z1� o <br /> MAILING ADDRESS }SCION wnN S S 33'0 VM <br /> 1 J tNl Y <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION"At `Sw` v `p p Z4-2r _v% 46 <br /> u "'ir S o �p <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ v, <br /> BUNKHOUSE ❑ 59.692(iV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT T <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: S '.sus <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> _� <br /> BUILDING CONTRACTOR: � H 6- O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 mh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. S n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m a o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, OJ` v <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (8) BUILDING(S) N <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �R <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. tyjj <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. m i <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 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. J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MV BE DONE WHEN "' y <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- <br /> 1. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. p n © I <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. Y <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER _ G <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> MA <br /> 6. <br /> 7. f4' n o 2 � 11 0 o n a <br /> @: <br /> 44 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my o <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the cletall and accuracy of all m>=: E:E. ;, ; y <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this m n>a to ti <br /> Information I am providing will be relied upon by the County of Burnett Wlsconsln 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 a <br /> application. I agree to permit county otttdals charged with administrating county ordinances or other authorized person to have so, <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. aatco 'j 5 w N f� <br /> OWNER'S SIGNATURE h 4/Z A I <br /> ` i / ��, (date) S $ It <br /> ZONING ADMINISTRATOR \ n F L/(�-t' loan 9� 854 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N »y <br /> P�✓m�+ fit led �-o �i.mu�I F�navol fo-8'I1 <br />