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� n Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ° <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNEtA�t� - l� LLQ L L L 1�.TT TELEPHONE ��/r�S"9 6 C �. O <br /> �1 �{ /'7 7 E <br /> MAILING ADDRESS <br /> 11 YYJJ d Jam/ / C/ ;/V P 7YC-1 / 1 <br /> PROPERTY ADDRESS �FS2 o Q <br /> LEGAL DESCRIPTIONPdY df q C1f )old, <br /> )*.def 3, �c6an 36 T39 R Ib, Meets" /i � o Cn <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE)4 ADDITION ❑ STAIRS ❑ ,,,} �. y <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO O DECK ❑ .o 4 <br /> ;t ° <br /> STRUCTURE/ADDITION USE: �H/nC-/'iN C7e <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c <br /> CC � <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS b C fo <br /> WILL BE RETURNED. n O o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Y <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C e. <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, mO <br /> AND INDICATE NORTH (N). 3.. 9 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) N o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK $ O <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 p ` <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. (may <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. v, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE w <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. -)r (� E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN �i ° <br /> NEEDED. �� f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: !S. <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. rb <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n OI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E C <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <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. E <br /> I declare that this application(includingan accompanyingschedule has been examined b me and to the best of m knowled a ;> 7y D m p D C b <br /> Y ) Y Y 9 A � ,� 9 R g F Ry <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ,°r n c a L,c A <br /> contained In this application(including an accompanying schedule and I further declare that I recognize that this information I z <br /> PP ( 9 Y ) Bo ,zwc ? w <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 further accept all <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to ° <br /> permit county officials rg with administrating county ordinances or other authorized person to have access to the above- «, w <br /> described premises at y rea nable tl a for Ne urpose o! spectlon o ZS' N—W o •y <br /> Sol' <br /> ., <br /> OWNER'S SIGNATURE m �' P <br /> n (date) e 6 m <br /> ZONING ADMINIST OR �� FI Qn IG�ah O " on <br /> >c z <br /> TOWNSHIP PERMITS MAY BE REQUIRED a g : ; <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE p: <br /> -�b /i Mrd& F047Lf-- 4-/ <br /> w H <br />