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z <br /> N� <br /> z Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a � <br /> APPLICATION FOR LAND USE PERMITS <br /> Asn <br /> W <br /> OWNER �rhJ � 5all� )i1 �W6 fCtd TELEPHONE <br /> 6l VlJ ��((,� <br /> MAILING ADDRESS N r f lk Ave- In1 <br /> „ 56-11 <br /> PROPERTY ADDRESS i =T <br /> LEGAL DESCRIPTION .� <br /> c <br /> TYPE OF PERMFT(S): SINGLE-FAMILY DWELLING ADDITION C DECK C GARAGE/ACCESSORY STRUCTURE ✓^ <br /> BUNKHOUSE C 59.692(SV)GAZEBO C STAIRS C FILLING/GRADING C CAMPING UNIT C ✓v <br /> a � <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION Cl COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: O r/� ( Z <br /> (Home/Cabin; Commercial usiness; Bedroom; Dec tc.) Cal1 <br /> h �� : ODDUBUILDING CONTRACTOR: ( T <br /> re�R N <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 ch X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. UJ <br /> r ( UJ <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) D o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (ES) AND ALL NEW <br /> BUILDINGS/STRUCTURES (N8), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, '. 4 <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o0 " <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O u} <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 4 <br /> TO BUILDINGS, ROADS,t*Ke,- fTT LINES. <br /> 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 o / " <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 f \^1 <br /> vV <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. r7 z, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n _ <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. <br /> 7. <br /> ' <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my a e a a ?= <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this a <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I 3 �: �,�= [ <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. 1 agree to permit county officials charged with administrating county rdinances or other authorized person to have <br /> o : ? <br /> access to the above premises at any reasonable time for the/purpose Ins>pection, c y <br /> OWNER'S SIGNATURE Y�LC`�/1.f1tLI�GV.CL` st'`I ✓TCG %'�—Q� 3 a c 86 - <br /> OWNER'S <br /> � o ,..1 <br /> cw � _ <br /> (date) o �' c c= •> o v ' z <br /> ZONING ADMINISTRATOR <br /> c m = C <br /> Y <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PER IT SHALL EXPIRE ONE YEAR F}kOM DATE OF ISSUANCE <br />