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C R Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS y <br /> OWNERn ," ,^� � OLynn �ELEPHONFy <br /> MAILING ADDRESS / /7 s� /i [L �n„iJ / iA Le ,L////Agee i <br /> PROPERTY ADDRESS Ill4 e/J(J�t/ 7dz- V!/ L!�/OY1?T.JT/l/� <br /> LEGAL DESCRIPTIO <br /> TYPE OF PERMIT(S): SINGLE-FAMILY * ELLING ❑ ADDITIIONJ /DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO STAIRS ❑ FILLING/GRADING D CAMPING UNIT ❑ 1 <br /> m <br /> COMMERCIAL BUILDING ❑ COMMERCI L-ADDIT,tION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: x � �VOIiV 'z <br /> (Home/Cabin; C//o,, / eer�ci�al Busi sus/; Bedroom; Deck; etc,.� / o <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 %X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o S <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m wy c <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Wv <br /> AND INDICATE NORTH (N). c J c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <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. <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. v, 1 <br /> 5. 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 pp o 4, <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. X-1 1i7�7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y O <br /> NEEDED. t� I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n S J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <br /> a d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. D <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. > 000maob <br /> m o E ts1 <br /> Fzo � � oo <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 ,2 B P � � ? oa .. <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 o `- D a m N ; <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 .� „ a w'= rd <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this e y d,v,`''^N b <br /> application. I agree to permit coon Rlclals charg with administrating aunty ordinances or other authorized person to have ” m,°� o o $ o .r„ <br /> P <br /> Y purpose of Inspection. S 0 <br /> access to the above-described I at an re nable time r the u pe <br /> 3 > g c o $ y <br /> l� �u� � a <br /> OWNER'S SIGNATURE n a y <br /> (date) c °o "2 <br /> ZONING ADMINISTRATOR I� —1' � N _ <br /> y �N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ? °° <br /> IS PERMIT SHALL EXPIRE ONE YEAR FROM PATE QF ISSUANCEin 1 a Cy N <br /> J �, �, 000c8 <br /> 3�/b <br />