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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a m� <br /> APPLICATION FOR LAND USE PERMITS : UI <br /> OWNER TELEPHONE , <br /> MAILING ADDRESS 8 39 Q IS*-) r WzbSkr �, I20 M <br /> PROPERTY ADDRESS '5L,38 ��S2n fL J <br /> G` 0 <br /> LEGAL DESCRIPTION c d <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION 0 DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO ❑ STAIRS 0 FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r <br /> ro <br /> 0 <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 09, <br /> O O- <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. n <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ^— m <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, 5 <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) a <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5. <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p Q <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. 1 w 1 <br /> 5. 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. 1 , `o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ) r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ) n z O C> <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 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 NI J <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. z Z > o 0 0 p a G 'V <br /> 6 <br /> x y 3 3 3 g 'o . <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I 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 a g, a a m N <br /> Information 1 am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .� 5 Y A ? > <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In thisapp <br /> accesication. I agree to permll:s to the above-described county emir e2clals charged an mosona with administrating <br /> for thelpu county <br /> ose of inspection. <br /> or other authorized person to have o o o i <br /> P Y PrP Pe m A iiowu oma' iY <br /> ICy /7N Q�VIO y � coog .j <br /> A 6 6 F <br /> OWNER'S SIGNATURE L <br /> �7 (date <br /> ZONING ADMINISTRATOR �IfY� fan I '(�/"� y�y .N °= w <br /> n C WF m rn <br /> TOWNSHIP PERMITS MAY BE REQUIRED C '° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> l�rrnt� a lee✓pr � �P bre t� shb <br /> 8-16-lo <br />