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Vb Z <br /> O O <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER <br /> TELEPHONE CGZ L�6L— S40 3 w <br /> MAILING ADDRESS v O <br /> PROPERTY ADDRESS <0 1 <br /> . � <br /> r <br /> o <br /> LEGAL DESCRIPTION �� lot. OE I�h�sQes-�lne5 L �lC I f.4J� <br /> TYPE OFPERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY-STRUCTURE ❑ 2 <br /> w^^ <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS FILLING/GRADING ❑ CAMPING UNIT❑ ` <br /> b <br /> r <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> A� n I z <br /> STRUCTURE/ADDITION USE: Syoo f-5 LC]k E> � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: GO C S GAF <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS .n <br /> c <br /> WILL BE RETURNED. n o. <br /> � O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C w <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <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, N <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S) y °� <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK d <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. L)j <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 F <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 7 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN � '1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: F .� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. N Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. sec Armes(®, <br /> 7. �yaagro <br /> � 'ry' 333ca - Cil <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0,5 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Ip = E R� H <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this c, 9 w 2 <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 a ii w'V ! 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this g N : <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to ° w w : o : o o <br /> have access to the above-d sc ed premises any reasonable time for the purpose of inspect! R 22 W N,, n <br /> 3 's1w c 0000 oo "� <br /> OWNER'S SIGNATURE <br /> (dAff4 a1 mno � <br /> a F w <br /> 20NING ADMINISTRATOR '2� SEP 2 7 ZoIZ 5 c. <br /> TONSHIP PER ITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAIMNING ry S <br /> N <br /> tJii to O O p O �' <br />