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U1, z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator S <br /> APPLICATION FOR LAND USE PERMITS : <br /> a <br /> OWNER WAVA.11S it �ST��a� TELEPHONE �i� 3�7- 8733 0 <br /> W `r o <br /> MAILING ADDRESS p <br /> PROPERTY ADDRESS 4;2,063.6FREE paI'y) �Rf✓E Fief D��fC� (a(r -SyN3 i <br /> 0 <br /> LEGAL DESCRIPTION _ AJ�Aj o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ \J <br /> 9 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION 0 COMMF%AaoACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: �E NeW AR'r• I(�G R P4JyeEo c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Chet. ao <br /> BUILDING CONTRACTOR: /2 t1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C c <br /> WILL BE RETURNED. .; o <br /> n °- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) br O <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 ' S <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). c 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 w <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O <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 /> 5. INDICATE IF A WALKOUT PASEMENT 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 E <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. j) <br /> i I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 'y <br /> NEEDED. l ' <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: r <br /> JI�'vJ <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. P <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. T � �o e o aO Fro7 <br /> h333 � 770o <br /> Fzo n � S3 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 _, = w <br /> .,� ,., <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all n m= ==a <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this v 1a.> n n^ a <br /> m n c <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I •e � yw 5: b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this g �+N: '=N 'V <br /> application. I agree to permit county officials charged with administrating aunty ordinances or other authorized person to haveB 0 8: 8 0 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. c m w N N M n <br /> `^ $00088 <br /> OWNER'S SIGNATURE /�(/ 7"`' L ate)/oS c <br /> ZONING ADMINISTRATOR <br /> G _ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N U 8 0 0 0 8 <br />