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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPPLLICATION FOR LAND USE PERMITS <br /> pWNERL)FG (/ L TELEPHONE�J/S-ti�6 ���p� c� <br /> MAILING ADDRESS <br /> ?630 Y_1I <br /> PROPERTY ADDRESS SrM /„ <br /> LEGAL DESCRIPTION Add 0 r,V/ TO kO/e- '841/f ' <br /> 9 7 <br /> TYPE OF vERMIT(5): SINGLE-FAMILY DWELLING 17 ADDIIIOL51� DECK❑ GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS 11 FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADD`IIJON COMMERCI IASL A�C/CFy�SORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE N',i G / �/� ��r /• I ' ` ' <br /> y�j ( (Home/Cabin CCommercial/Bussmessc edroom; Deck; etc.) <br /> BUILDING CONTRACTOR: / rt- �C /J ��D'I'` C/ /-5 N I j <br /> r <br /> T I(? c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V.X11 SHEET OF PAPER, ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS .C,. 1 'c <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PUN DRAWING: (AREAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. = T <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH NU. <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C)BUY-DING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE, STRUM OR RIVER AND WETLAND AREAS,AND EN LOT DIMENSIONS. <br /> 4, SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 4 TO BUILDINGS, ROADS, FAKE, LOT LINES. - <br /> S. INDICATE IF A WALKOU r BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PUNS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE R; <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. d f 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (S( <br /> NEEDED. L <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER r- <br /> S NOT OK EYlSTRUCTURE/GARAGE PERMITS <br /> TRE/GNTS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. v S <br /> 6. <br /> 2 > n ncn> cw <br /> I declare that this application(including any accompanying achei has been examined by me and to the best of myFp,j ' <br /> knowledge and belief it is true,correct and complete. I acknowledge that l am responsible far one detail and accuracy of all _ - - -1 <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this > GN ; <br /> information I am providing will be relietl upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> a _ S <br /> further accept all eetoity perml may bearesult of red unty witha fBurned ingcrelying <br /> county <br /> thisinformationmother providing dP Person <br /> application. ]agree to permit unry o?cials charged with administrating county ominances or other authorized person to - d <br /> have access to the above-de rbedpr tan To urpose of inspection. p w (] <br /> OWNER'S SIGNATURE <br /> ZONING ADMINISTRATORZ OCT 9 2013a Z + <br /> c .T. <br /> a ? <br /> TOWNSHIP PERMITS MAY BE REQUIRED B 1RNETT COUNTY - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING <br />