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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 /> OWNER fL f?/'f flJ TELEPHO%� f <br /> MAILING ADDRESS(GG l A 9 i f C (�!J <br /> !'i <br /> PROPERTY ADDRESS ���57 <br /> J J o <br /> VI's /z z kods ,?F /3 04f E yy Szff <br /> LEGAL DESCRIPTION o .� <br /> 1 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTUR v, <br /> 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin; Com ercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 hk X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS p o_ <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ^- <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, a <br /> AND INDICATE NORTH (N). 1 o z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) p 8 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK U,1 m'. <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 4- <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. SU F �, I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE W ^^ o (A <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. J DQ _ p <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. W p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> (O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C!, n z � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c A <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 6 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. v <br /> 6. <br /> 7• s > L)0 o n a o R7 <br /> n ry B 3 3 A a £ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 ,z g ,o., i <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a m F, rrn .j <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I Y> <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 " ;�, ,°a o o o0 0 <br /> access to the above-descrlbed premis any reasonable time for the purpose of in on. m R a o w w o o y <br /> A = DEi <br /> o 00 0 0 0 ^1 <br /> OWNER'S SIGNATURE 2 2 <br /> (date) <br /> a <br /> ZONING ADMINISTRATOR <br /> O o n <br /> TOWNSHIP PERMITS MAY BE REQUIRED (" <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> U � 00000 <br /> 10ermi f d- le fk,(- P1C'k_d U(_P b�� Pie ha"01 to jh- <br />