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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator $ ° <br /> APPLICATION FOR LAND USE PERMITS <br /> N F rn <br /> C v ) <br /> OWNER TELEPHONE .17 <br /> 011 rla-6ysS I <br /> Ql <br /> MAILING ADDRESS �Qgn - re� <br /> PROPERTY ADDRESS 08�Z/ <br /> J J n 1 <br /> °e C �. <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT O , <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ,❑/n,C/O,MMERCIAL ACCESSORY STRUCTURE ❑ <br /> A <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> D <br /> BUILDING CONTRACTOR; ` n C� <br /> O � <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) M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH (N). N Y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 <br /> 4. SOMOEC <br /> FLAKE, STREAM OR RIVER AND TIC <br /> LOCATION OF THE WELL (W)S P <br /> HOWTHE TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES \ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5. w <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. `SJ4 <br /> l Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r 4" <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. z C; <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 ._. <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. acoona 'a <br /> 6 <br /> g o' <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0,°2 R �^ `� ? w 3 <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 �" 9. D a 51 N <br /> Information I am providing will be relied upon by the County of Burrett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burrett 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 m '2 <br /> access to the above-descmbep mileI' ls at any reason le time for the purpose of inspection. D Ca y <br /> �I �� <br /> OWNER'S SIGNATURE � Ljj " /' / yr d o_ W do Q = OZ <br /> (d ) <br /> E n [+7 <br /> ZONING ADMINISTRATOR J(r�(�l / rlanti j2 \ y X = c <br /> s _ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Pe%4 .r le-f-fe✓ lot Ck ed �'t p b q &2e, <br />