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Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator < y <br /> APPLICATION FOR LAND USE PERMITS <br /> �y" � L ) � a <br /> OWNER GfI_ _1 ,�DII✓1�iA) J , <br /> TELEPHONE ��� n�� /3 jJ/a2 d <br /> 75 Cl U 7 .., � <br /> MAILING ADDRESSm� <br /> ° <br /> PROPERTY ADDRESS <br /> CI l G u ` <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ '� T <br /> COMMERCIAL BUILDING El COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTUREX S �. <br /> STRUCTURE/ADDITION USE: 76sr S/ e H?-�"' o <br /> / <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 6/ 1I./kin/ r) Cy <br /> TMJ < <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O o <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> d <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c!. R <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, J 9 <br /> AND INDICATE NORTH (N). N RJ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS) <br /> a <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 00 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. SU O <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. 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. 7l� 1 <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN �} H C� <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. 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. Jk�' <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. p <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. U <br /> NOT�TO E USED FOR HUMAN HABIT�`ON. G <br /> 6. G -1 �Se �h1I e r�� L� & t�er�� - <br /> 7. ([CS+ e r sin 000C1cb <br /> nt � n <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my p ° ry A B:E <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all El <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <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 iia_ ; a <br /> further accept all liability that may be a result of the County of Burnett relying on this information lam providing in thism 3 ! �.iz N 7 <br /> application. I agree to permit county officials ch a ad with administrating county ordinances or other authorized person to Sm o o C <br /> N <br /> have access to the above-de bed prems at a reasonable time for the purpose of inspection. g yR a <br /> Q) <br /> U ° oWNN ,, <br /> ` <br /> OWNER'S SIGNATU c 6 o Q o g date) ori , <br /> ZONING ADMINISTRATOR <br /> Fs?. En' a� a7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 2012 n = to <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCBURN <br /> E1T COU <br /> ZONING <br /> n n000 00 <br />