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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P <br /> APPLICATION FOR LAND USE PERMITS y to <br /> OWNERo� TELEPHONE <br /> .conn SM�r � laLa /3�bo v <br /> MAILINGADDRESS 2I�/ II .jr-i /�. 9d9d3s �J, b(�L� �JT83V!\ O <br /> PROPERTY ADDRESS a7 <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 5 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 I , <br /> 9 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; mmercial Business; Bed m; Deck; etc.) <br /> BUILDING CONTRACTOR: n � <br /> of � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ^p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (ES)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) Q <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. O C" <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. w <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. til <br /> NOTE: Q/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r 1Z <br /> n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z Vl 03 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 8 M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r r, <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. C <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> 8 -. 3 5 3 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 9 0,°Z 0.01_aq.S?w <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all 5 m m m `=a : y <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this "'� 9 9 tl+,`O, <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I B c n S w S. b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> axes to the above-described prem at any reason me for the pu se of inspectlon. - m C, <br /> 1ST <br /> 08- <br /> 2/ . <br /> OWNER'S SIGNATURE a H a m^pp �' <br /> (date) g H 8 R 9 Z <br /> ZONING ADMINISTRATOR <br /> a 1f c: <br /> � n <br /> TOWNSHIP PERMITS MAY BE REQUIRED G <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE t,ti N 2»N" <br /> N N$O O O$ <br /> �.�/n�) f �l2�'�-e✓SOI�G� ��=� b� ��(i����� <br />