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e � z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITSCV <br /> y: y <br /> C50 <br /> OWNER rp <br /> ,,ZLEPHON - _ 3(�30 <br /> V n <br /> MAILING ADDRE S / <br /> ES i Qoi <br /> �s6—a� 1 <br /> PROPERTY ADDRESS f J _ /' - J v 7 <br /> C�Tl��30ago �_ I DfL ,�� <br /> LEGAL ES I n( / CSM y P Z r l LGt. (3�d� 'i a, 1 ^ C- <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ � <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UN <br /> 7� t <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURED r' <br /> 0 <br /> STRUCTURE/ADDITION USE: c 1 v <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: n C <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O o <br /> WILL BE RETURNED. <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARiAL OR TOP VIEW) <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 (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, C71 v <br /> AND INDICATE NORTH (N). p I o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 'a ^ O <br /> Sj <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 6' <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. d -Z p p <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. R w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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 <br /> vl 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: ( d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. raj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 8 Z cCiS <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 6 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. v i <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. y o 0 0 6 <br /> x n 3m i= <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my o,°z R = 5w <br /> knowledge and belief K Is true,correct and complete. I acknowledge that I am responsible f6r the detail and accuracy of all a m w e: a:. y <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 or aumett Wisconsin in determining whether to Issue a penult. I .�'w= <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this o `^N V sA o r- <br /> access <br /> I agree to permit county officials charged with adminlsb aUng county ordinances w other authorized person to have 10 <br /> oo : go w. <br /> atcess to the above-described premises at any a the purpose of inspection. E°mE a o'N w N w f7 <br /> Qtl Ky Y000 <br /> OWNER'S SIGNATURE // n�funh o`y,o m n C' <br /> ZONING ADMINLSTRATORG�n( (date ti a <br /> 8 tr1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N " <br />