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c n Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator g a, <br /> APPLICATION FOR LAND USE PE MITS y <br /> OWNER ll/��� �N TELEPHONE <br /> r ppp m <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS a0 <br /> LEGAL DESCRIPTION S 33 n A , AJ4J /�� r✓GtJ�� Sa�F'� F 3'I1"I 1( 1964J o <br /> TYPE of PERMIT(S): SINGLE-FAMILY DWELLING Q ADDITION ❑ DECK❑ GARAGE(ACCESSORY STRUCTURE❑ <br /> � A <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ (� <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDPON ❑ COMMERCIAL ACCESSORY STRUCTUR CI!'` <br /> STRUCTURE(ADDITION USE: V;/!� <br /> (Home/Cabin; Comm tial Business; Bedroom; Deck;etc.) ° —L <br /> BUILDING CONTRACTOR: <br /> p � C <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. m <br /> e <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW PI w o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 6 <br /> a <br /> AND INDICATE NORTH(N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDINGS) o P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <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 <br /> TO BUILDINGS,ROADS,LAKE, LOT LINES. <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 0 <br /> o � <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN W <br /> NEEDED. rp ,J <br /> W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �, w <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. m Z A W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a O <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. O ob <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. o <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. T � � 000�c9. a � <br /> " ' <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge 3 0 '� ` P w <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information li <br /> a : <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I D D m <br /> am providing will be relled upon by the County of Burnett Wisconsin in determining whether to issue a permit I further accept all 2 n v <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to c $ H N <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- �° n $ o o .. <br /> described premises at any reasonable time for the purpose of Inspection. B m »L,g«, <br /> oil <br /> o <br /> OWNER'S SIGNATURE 't ep m 0 N Z; <br /> (da 0 � d5 3RE, _ <br /> dim Fldn�� <br /> ZONING ADMINISTRATOR O w w' s yn <br /> TOWNSHIP PERMITS MAY BE REQUIRED a C': <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE Of ISSUANCE v a !2 « �» <br /> i�e� ��4hif��lC7ced u� bu� �( �el{��eh <br /> �-asc� U � 8888 <br />