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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 1 (�Z2 <br /> APPLICATION FOR LAND USE PERMITS v <br /> f <br /> OWNER TELEPHONE / qt,-7, t, V,1 <br /> MAILING ADDRESS <br /> `1 ltti l i <br /> PROPERTY ADDRESSq3 c Q� <br /> LEGAL DESCRIPTION �l �J+ , C- `✓� <br /> TYPE OF PERMIi(5): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK EI GARAGQACCESSORY STRUCTURE,$+ <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO O STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> �/O y <br /> STRVCTURE/ADDITION USE: C / Y(3I�D <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc. O <br /> z <br /> BUILDING CONTRACTOR: SSC C <br /> n <br /> AP LOT PUN MUST BE PROVIDED ON AN 8 Vs X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. C <br /> DIRECTIONS FOR PLOT PUN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL ENISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW d <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). P T <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) <br /> TO CENTERLINE OF ROAD,(q BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK r" O <br /> (OHWM)OF FAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. -S <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PUNNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE - <br /> PUNS 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 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, n Z <br /> 2. REMOVAL OR CUTFING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER J <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NNOTj TO BE USED FOR HUMAN HABITATION. <br /> ]. '(�. �,lr�(1 dYY'Pi V / 11�-( 1 Va aF > nr. r. c6i - <br /> ^ n n 3 <br /> F 7: <br /> d <br /> I declare that this application(including any accompanying schedule)has been examineby me and to the best of my 3 0 <br /> knowledge and belief itistrue,correct and complete. 1 acknowledge that 1 am responsible for Ne detail and accuracy of all == e <br /> infomMtion contained in this application(including any accompanying schedule)and l farther declare that i recognize that this <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether be issue a permit I - - S <br /> farther accept all liability that may be a result of theCounty of Burnett relying on this information l am providing In this 5 N '-^'^ S <br /> application. I agree to Permit county officials charged with administrating county ordinances or other authorized person to ^ V - $ aR <br /> have accesslotha v - ed premi a[anth <br /> y reasonable time purpose of inspection. <br /> OWNER'S SIGNATURE 9 A <br /> (da ) 5 <br /> 2v, >� xnc Y -. O <br /> ZONING ADMINISTRATOR T <br /> a T <br /> TOWNSHIP PERMITS MAY BE REQUIRED = _ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />