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C m O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning AdministratorUj <br /> g <br /> APPLICATION FOR LAND USE PERMITS i <br /> OWNER 5�� - �� 1 I/D TELEPHONE d <br /> /\ w <br /> MAILING ADDRESS 43-75 Cott _ / rip &33 f< /' ,� Q 6I r(kr.IQQ 026 63W <br /> 1 <br /> PROPERTYADDRESS (oq ( � CDu i7fL� /-r l-G <br /> LEGAL DESCRIPTION S <br /> TYPE OF PERNIf(5): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE I (� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> n <br /> COMMERCIAL BUILDING ❑ COMMERCIALADpI/TION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ � <br /> STRUCTURE/ADDITION USE: fit e BIn.I t0/ o <br /> (Home/Cabin; CoWmercial Business; edroom; Deck; etc.) O <br /> BUILDING CONTRACTOR: y <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c <br /> WILL BE RETURNED. <br /> A a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) to p <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 NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). 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. d <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. rW <br /> I'� <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.,THEr ,V <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. �vdl <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t^ T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 0 'Z p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. S <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. a � � o0o p�p±± a �l <br /> R n y 3 3 '� <br /> :Z <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 o ; <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all 8. p7 R.e. e. <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that thisv ° 9 9 to N f <br /> Information 1 am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 1 am providing in this 6 cn N <br /> application. I agree to permit county officials charged with administrating court ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the p f Inspection. ,� a i3 <br /> w <br /> o i <br /> 3rd � a <br /> o. <br /> OWNER'S SIGNATURE ( —f n (A a a <br /> (date) 0 o. o E i6 6', <br /> T _�V-� /� I �o <br /> ZONING ADMINISTRATOR �J 'r ' ' I l�� <br /> TOWNSHIP PERMITS MAY BE REQUIRED G <br /> THIS PERMIT' SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v H U <br /> h'e 6-6i-} i l e-f-Y K �l Coed U100� j�)e 6)Oeh <br />