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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator i <br /> APPLICATION FOR LAND USE PERMITS N <br /> OWNER /(r1U,�nI.�- Clj��pi /o �I 1/ TELEPHONE o (� <br /> MAILING ADDRESS +��✓7�D DI ,-I CI'/D� In )T / lR�a <br /> PROPERTY ADDRESS ofd 35- <br /> n <br /> < I <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION 0 DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 1159.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING 13CAMPING UNIT ❑ r Cq <br /> b <br /> COMMERCIAL BUILDING El COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: <br /> V/L7 1 <br /> /J U;-h h 7 U <br /> (Home/Cabin; Commercial Business; Be om; Deck; etc.) _pj <br /> BUILDING CONTRACTOR: n , <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m O <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, G 9 <br /> AND INDICATE NORTH (N). <br /> 3 OCENTERLIID <br /> NE OF ROAD, BUILDING M ASUREMENSIONS IN FEET OF THE FOLLOWING: (A) BT(S)TO THE LINES,TO ALL LOT ) BUILDING(S) <br /> ORDINARY HIGH WATER TOp S bO O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES q <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. >,.l <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. TJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN V'I ..I I C <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Or <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. Ca A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. fU <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER C> <br /> SETBACK AREA. I J <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. IT, <br /> NOT TO BE USED FOR HUMAN HABITATION. G <br /> 6. F <br /> 7. n a o 0 o n c° ro <br /> jr. rM <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 12 2 2 ? w' <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all d m — d- <br /> Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this a a m ,`O„ <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I $w b <br /> further accept all liability that may be a result of the County of Burnett 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 <br /> access to the above-described premises <br /> at any time <br /> for the purpose of Inspection. m w a o w Di <br /> OWNER'S SIGNATURE <br /> v, a <br /> (date) o $S F 9 d - z <br /> i <br /> 3 <br /> ZONING ADMINISTRATOR \ E`/Oo(f/K�`n� n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE u,« " <br /> � � 0000S <br />