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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning AdministratorB. <br /> c ° <br /> APPLICATION FOR LAND USE PERMITS �y h <br /> OWNER - TELEPHONE �_(4(0 C(0 <br /> S ebrasse a <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> 5:Z4 <br /> -7 H Suss LLR� lel ask w� o <br /> LE AL)/,ESCRI ION N lnl Seg�Im i ou-n>h,p 3c1 ),) IL W QT V W �'' ' 4- <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> 0 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (H/one/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: /V/YI G:1 <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. 0 9) <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r a <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 NEW0 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v <br /> AND INDICATE NORTH (N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. d <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DISTANCES r <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ' <br /> S. 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. C y <br /> NOTE: BUILDING/STRUCfURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. � C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r o <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. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, p. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. (r p <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. S � 000 o�aE <br /> 9 a 3 <br /> I declare that this applIcatim(including any accompanying schedule)has been eamined by me and to the best of my B o,°Z �.9, ' ? w <br /> M <br /> knowledge and belief It Is true,correct and complete. I acknowledge at I am responsible for the detail and accuracy of all 2. ' m = !°•a : y <br /> Infortnatlon contained In this application(Including any accompanying schedule)and I further declare that[recognize that this c_>> to `O <br /> Ir formatbn I am providing will be relied upon by the County of Burnett Win in debammirg whether to Issue a permit. I <br /> further accept all Nobility Mat may be a result of the County of BumeM relying on Mls Information I am providing len this o <br /> application. 18"to Permit county officials larged with adriftsoati g county ordinances ar other authorized Person to have <br /> access to the above-described prernlses at any reasonable time for the purpose of Inspection. Do (] <br /> --7 3Aga� SoSSy <br /> OWNER'S SIGNATURE c?'s <br /> (data) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ro: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE « =N <br /> f�rmt! IQ f�e� plied up be/ La t ,-e <br />