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1. <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER (,'j� TELEPHONE <br /> MAILING ADDRESS / i,dj_ �/ N`- t,_- ST/ / v IJ <br /> oVO� ✓ 7 Yt� r `3 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTIO 5/y T;jya/ /fie uJ=�nt <br /> TYPE OF PERME(5): SINGLE-FAMILY DWEWNG Cis ADDITION DECK 17 GARAGE/ACCESSORY SIERUCTUItE <br /> BUNKHOUSE Cl 59.692(1V)GAZEBO ❑ STAIRS CI FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ _ <br /> STRUCTURE/ADDITION USE: J� / as z _ <br /> (Home/Cabin; Comore ial eu cess; etlmom; Deck; etc.) <br /> _BUILDING CONTRACTOR: _Sk J <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS F o_ <br /> WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. G <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW mO n <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v <br /> AND INDICATE NORTH(N). <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 MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK O'p ms- <br /> (OHW M) OF TAKE, 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 S11 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSETE VERIFICATION MY BE DONE WHEN .y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: " <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. o .Z <br /> Z. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WEHIN THE REQUIRED WATER <br /> 5.__ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDE <br /> GARAGE/STORAGE,ONLY,_ <br /> NOT TO BE USED FOR HUMAN HABITATION. ( ' <br /> 6. <br /> 7. ^nT 'p annnC]D6p � <br /> ' ' 333E9n � <br /> I declare that this application(Including an n ri 4 ' ° <br /> y a¢alete. I ac wheedle)has been examined of r t and to the best of my 3 0,� <br /> informknowleage and belief R is We,carrelln(including mm a I ccumwinyin that 1 am responsible for Me end and ec gnize of all >m a <br /> information I a mired in[bis apptica6on uMt e c unty of turn schedule) in I determining <br /> declarehe Mat I recognize that this c.9 9 m $ <br /> infonmaacc I am providing will be relied upon by the county of Burnett Wisconsin in tlenforma io whether to issue a permit 1 _ <br /> PorNer ion. I all lie top that may beo newt[of the County of Burnett relying county <br /> this information I r a p horizeg in this '�+ <br /> application. 1 agree to permit county officials re9etl with atlmWithe pu county ordinances or other authorized!person to have <br /> access m Me abovrtlesaibed premises at any reasonable Gore for Me purpose of i ection. m w c a W o Z <br /> l ay_1q R ;vs <br /> OWNER'S SIGNATURE o ry a_m n o ++ C <br /> date) 5 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PER rrS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU MAY 8 2014 u o 0 0 0 <br /> SURNETrCOUN7Y <br /> ZONING <br />