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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g P <br /> APPLICATION FOR LAND USE PERMITS y <br /> OWNER / j� TELEPHONE ❑ °' �� <br /> r G art d /�iso/JG M L,t ,., <br /> c <br /> MAILING ADDRESS � <br /> 3 Z G oo E'rl c Cou.fi; � AW SS0 79 <br /> PROPERTY ADDRESS <br /> LE AL DESCRIPTION 5' <br /> T <br /> /4,2 .,N iia fiber /anaClilosanew i/;llt4e sz?TyoN; Riau/ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK ❑ G AGE/ACCESSORY STRUCTURE ❑ d <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING,'❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ �' 5 <br /> STRUCTURE/ADDITION USE: >/lornG_ c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: &C/I/ r) (JI <br /> °Q_ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 o 9) 0 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) s 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW ro w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, I p <br /> AND INDICATE NORTH (N). N 1�- o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) °c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S' p �, <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. ty <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 5. SIJ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ,�, I <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 <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 y y P <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r" G (j <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 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. V I <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. � �0 >o o o L) Ri 60 -0 <br /> B <br /> 7. n n ro 0 o <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 6'9 0 ,� B B . . y. �r <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Ip 'ms ., �;A: ,..) <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this o 5. > > W ,`Q <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I w a: c a ' '� a <br /> S <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 1 am providing In this t <br /> application. I agree to pe conn clals charged with administrating county ordinances or other authorized person to o <br /> have access to the above described pre Ises at any reasonable ime fore u se of Inspection. o^ > : in 5 f1 <br /> A H U 0 0 <br /> OWNER'S SIGNATURE •� )et <br /> a <br /> d�/B <br /> r 2 a <br /> '� r <br /> ZONING ADMINISTRATOR LJ I Vn 1 [a6 gqj oc. : I, EyC <br /> TTT777 y CN = w 8 � � <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE SUANCE ? o <br />