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i <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> Le (To k r,s(-)(\,j <br /> MAILING ADDRESS �O 3 CJ J I1 C'J' / n(�r1.1 sr1 ' .M u <br /> PROPERTY ADDRESS l/1J C I J)� OA (( <br /> (( TTLL ( /V `ls U h /I I II�— <br /> LEGAL DESCRIFRONpi t i-V I'1 c.� m UU I ^n� <br /> TYPE OF PERMIT(S): SINGLE FAMILY DWELLING ❑ ADDITIO CK 'GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ .z S <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ � <br /> STRUCTURE/ADDITION USE: ASI,+,D� <br /> (Home/Cabin; Comms tial Business; Bedroom; Deck;etc.) W <br /> BUILDING CONTRACTOR: La1.0 �IGMnS Z/Y• <br /> z <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h%11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C j_ G <br /> WILL BE RETURNED. <br /> T <br /> DIRECTIONS MRPLOTPUN ENSION OR DI (A CES O E SHOWVIEW) c. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR <br /> BUILDINGS/STRUCTURES DRAWN TO SCALE. r' R <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING PORCHANDOTHES (EB)AND ALL NEW qq c <br /> BUILDINGS/STRUCTURESIN(NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, �l <br /> ANDINDICATE (N). i0 y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) <br /> (O CENTERLINE , ROAD,(Q BUILDING WETLAND AREA ,A THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <br /> 9. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(5T)AND GRAINFIELD(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. ? Ih - L <br /> 6. IF SEPARATE PIANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE y <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. '^ F ` w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � d <br /> L DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN GO DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. `C`T : z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. T' <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER d <br /> SETBACK AREA. <br /> AREA. <br /> S ACCESSORY USEDSTRUCTURE/GARAGE <br /> E/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO q ` <br /> 6. Q` <br /> ]. ,, ,t > rynnC: > <br /> = z <br /> Ideclare that this application(including any accompanying mhedule)has been examined by me and to Me best of my 7 <br /> q <br /> knowledge and belief it is We,correct and complete. l acknowledge that I am responsible for the detail and accuracy of all va <br /> informrtion contained in this application(including any accompanying schedule)and l further declare that l recognize Mat this <br /> information I am providing will be relied upon by Me County of Burnett Wisconsin in determining whether to issue a Permit. I = = > <br /> further accept all liability that may aresult of the county of Burnett relying on this information l am providing in this <br /> appllcation. I agree to permitcou - offltiak ch rgetl wi[hatlminirtratinq county oNinanJ(date) <br /> zed person to <br /> have access M Me above-des Pro ize a ny reawnable time for Me purities of insp /� _ <br /> _ > <br /> OWNER'S SIGNATURE x ZONING ADMINISTRATORCT 14 2�';3 <br /> F3T <br /> TOWNSHIP PERMITS MAY BE REQUIRED BUR CC)UN1Y a m <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCF'QNING 8 <br /> Nua� o = = <br />