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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator � t <br /> APPLICATION FOR LAND USE PERMITS M a <br /> OWNER / y/ , TELEPHONE - a <br /> Char ns 7�, e/eh lz�z-z �o-s� d 7 <br /> MAILING ADDRESS <br /> /09i e/1 �sQuZ�L;,tI/��l()Cu�pk_4RAl ssaiy ;^ <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY—DWELLING�11 ADDITION ❑ u DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ / ) <br /> BUNKHOUSE D 59.692(1V)GAZEBO❑ STAIRS D FILLING/GRADING ❑ CAMPING UNIT D 2 V <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION D COMMERCIAL ACCESSORY STRUCTURE D S' <br /> STRUCTURE/ADDITION USE: l q";' <br /> (Home/Cabin; Commercial Busine ; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> r � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS as o_ <br /> WILL BE RETURNED. O _ <br /> n <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIALORTOPVIEW) m o' <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 m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O ., l <br /> AND INDICATE NORTH (N). J 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. 1 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. a l <br /> 5. INDICATE IFA WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. H <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE 1 <br /> PLANS MUST BE SIGNED AND DATED BYTHE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN i <br /> NEEDED. <br /> UJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: F <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS RWITHINESTRICTED <br /> 60 DAYS OF PERMIT. I <br /> 2. REMOVAL OR CUTTING EL TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING ES SNCLUDING ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER r� <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. E <br /> 2, & sagog r, 00ao % <br /> m 33 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to Me best of my <br /> knowledge and belief R is true,come¢and complete. 1 acknowledge flat I am responsible for Me detail and accuracy,of all <br /> Information contained in this application(Including any accompanying schedule)and I further declare Mat I recognhe Mat this c_D D W N Y <br /> Information I am providing will be relied upon by Me County of Bumett Wisconsin in determining whether M Issue a permit. 1 5 R '> <br /> further accept all liability Mat may be a result of Me County of Barnett relying on this Information I am providing In this _ w r y'�'i^(v d <br /> lica <br /> apption. 1 agree to permit county officials charged with administrating county ordinances or other au fort ed person to have _ a <br /> access to Me above-deschbed premises at any reasonable time for Me purpose ofInspectlon. u O V W N o a <br /> OdEr <br /> OWNER'S SIGNATURE <br /> sad y dMAY '92014 � 2 " M7 M <br /> ZONING ADMINISTRATOR a n <br /> oC: _d <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUIi <br /> w 1 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING <br /> �000 0 <br />