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z <br /> 3 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 50/� . <��)hr�Spn <br /> MAILING ADDRESS -P r )?T LT1Y siib-u� F- <br /> PROPERTY <br /> _ <br /> ADDRESS / / \ <br /> LEGAL DESCRIPTION / / <br /> TYPE OF PERMIT(5): SINGLE-FAMILY DWELLING O ADDITION O DECK O GA 7RAGE/ACCESSORY STRUCTURE E1 <br /> BUNKHOUSE O 59.692(IV)GAZEBO O STAIRS O FILLING/GRADING❑ CAMPING UNITO <br /> COMMERCIAL BUILDING On COMMER!i-A'2 �DITION O COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: Yin LF_ .j� YfI�STO/�gG P. �J`J /K II/P/ o <br /> (Home/Cabin,Commercial Businn , Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> AP LOT PIAN MUST BE PROVIDED ON AN 8'/a X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS r L^ <br /> WILL BE RETURNED. — <br /> r <br /> DIRECTIONS FOR PLOT PUN DRAWING: (ARIAL OR TOP VIEW) r G <br /> I. 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 2 <br /> BUILDINGS/STRUCTURES(NS),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT ONES,(B)BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATERMARK I P <br /> (OHWM)OF LAKE,STRUM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. £� <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES v 1 <br /> TO BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE s <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Cy — <br /> Lb d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: 1 <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, O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. CD £ <br /> 6. <br /> z „ z ^ ,. n n > _ T <br /> a' � R '3 '33n ` ^ z <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my .k , <br /> Knowledge and belief it is true,correct and complete. I acknowledge Nat 1 am responsible for the detail and accuracy of all <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 Bement Wisconsin in determining whether to issue a permit I <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 /> applicabon. Iagree to permit county officials charged with administrating county ordinances or other authorized person to <br /> have access to the above-describe premises at any reasonable time for Me purpose of inspection. _ � > ' sL, - (� <br /> OWNER'S SIGNATURE �� �� ,H--�� Ir _ c_ R , <br /> (date), <br /> a to >'? <br /> ZONING ADMINISTRATOR FEB T-2014 _ 2 n t*i <br /> TOWNSHIP PERMITS MAY BE REQUIRED t(./NV\I <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISStMqNETr OOUNTy R _ <br /> ZONING u <br />