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Burnett County 7410 County Road N, No. 102, Siren,WI 54572 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMIT <br /> ce!I) �9 <br /> OWNER ehi <br /> TELEPHONE <br /> MAILING ADDRESS <br /> i./ /6o 73 vhn 1) L Z \(I— <br /> ' ' <br /> PROPERTY ADDRESS �V� <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMTHS): SINGLE-FAMILY DWELLING ADDITION DECK ARAGE/ACCESSORY STRUCTURE <br /> E <br /> BUNKHOUSE• 69.692(1V)GAZEBO STAIRS FIWNG/GRADING CAMPING UNIT �- <br /> COMMERCIAL BUILDING /CWME�RRCCIIALLADDITION COMMERCIAL ACCESSORY STRUCTURE <br /> STRUCTURE/ADDITION USE: b7l, L tcy <br /> (namet�/l-JCabin;Co/mmeraal Business; Bedroom;Deas;etc.) <br /> BUILDING CONTRACTOR: ] Uri l'iIt'llhd. )f LJf I(�lhuS .,`/ Lb <br /> / S <br /> z _< <br /> AP LOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> L ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r" _ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW O o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). a o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)WILDING(S)TO ALL LOT LINES,(B)BUIWING(S) p d <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �. <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. pi <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, XJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE l <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRURURE LOCATIONSMUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN ' <br /> NEEDED. <br /> THIS PERMIT IS SUBIECr TO ALL CONDITIONS LISTED BELOW: ryr <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTSWTTHIN60 DAYSOF PERMIT. d <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. S <br /> 6. <br /> I declare that this appliration(including any accompanying schedule)has been examined by me and M the hart of my 3 Fe, <br /> knawledge and belief it is true,correct and complete. Iacknowledge that am responsible for the detail and accuracy of all a .E_E=.o -] <br /> information contain!in this application(including any accompanying achedule)and IFather declare Mat l recognize that this 2 F > c� ; Y <br /> information I am Providing will be relied upon by Me COunly of Burnett Wisconsin in determining whether to issue a Permit. I o- <br /> further accept all liability that maybe aresult atthe my of Burnett relying on this information l am providing in this _ Ou <br /> application. l agree M Permit county officials chaye YM administrating county ordinances or other authorized person to 2 <br /> have access to the above-describ pfmisas at any hsonable time for Me pu uOf inspeafon. ? Vi > f� <br /> S <br /> OWNER'S SIGNATURE 3 n s <br /> ZONING ADMINISTRATOR ���\, q.p.. _ D _ = 2r � -+1 <br /> —rrrHf�uO ZuIJ - ' - M <br /> C R <br /> TOWNSHIP PERMITS MAY BE REQUIRED q��p _ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS4AN&ETT COUNTY <br />