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° <br /> y <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 office of Zoning Administrator a 3. <br /> APPLICATION FOR LAND USE PERMITS _ J <br /> o <br /> TELEPHONE rl/-� <br /> OWNER CTcc� �Ue <br /> MAILING ADDRESS J�'7 �� / ��Ti-) /-t�ji:Q� l V.l-t1/ CC"I C�/li"I� <br /> p y <br /> PROPERTY ADDRESS �1 _ 'i _ 'I -(��� �'C�L- /C.L[' S C7 <br /> LEGAL DESCRIPTION N ( , <br /> rt w' 1 <br /> TYPE OF PERMiT(B): SINGLE-FAMILY DWELLING ❑ ADDITION DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ � <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING CICOMMERCIAL ADDITION CI COMMERCIAL ACCESSORY STRUCTURE ❑ , �o <br /> oo I 1 <br /> STRUCTURE/ADDITION USE: �'I C !� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> n <br /> BUILDING CONTRACTOR: <br /> INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> A PLOT PLAN MUST BPAPER.E PROVIDED ON AN 8 'h X11 SHEET OF ANY vi - <br /> WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN UILDINGS/DRAWN R SCALE. w <br /> 2. SHOW THE LOCATION AND SIZEOF <br /> ALL XI TINGDECKBPORCHES/AND OTHER STRUCTURES, NEW <br /> BUILDINGS/STRUCTURES (NB), <br /> AND INDICATE NORTH (N). C� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,RY HIGH DINATE BMARK <br /> UILDING(S) <br /> TO CENTERLINE OF ROAD,(OHWM) OF LAKE,STREAM(OR RIVER AND WETLAND AREAS,AND (D)NG MEASUREMENT(S)TO THE LOT DIMENSIONS.ALL D STANCES <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF), <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. --1 <br /> ETC.,THE <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW ENGINEERS BUILDER,R�CONTRACTORED. � < <br /> 6 ITTED BY AN ARCHIT <br /> PLANS MIF RUST BE SIGNED AND TE PLANS ARE MDATED BY THE OWNER <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY 8E DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z SI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'p <br /> 4. NO STRUDCTURES INOCLUDING RETAELAND INING WALLS, TCTIONS ARE .,ALLLOWED WITHINED UNLESSFICALLY THE REQUIRED WATER <br /> SETBACK AREA. LLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I <br /> 5, ACCESSORY STRUCTURE/GARAGE PERMITS A L u✓ E <br /> NOT TO BE USE FOR HUMAN HABITATION. G \ �� _� <br /> 7, b 2 o <br /> I declare that this application(including any accompanying schedule)has been examined of r t and t the best u my c > <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy e)and I furtherh all <br /> information Information contained m providing iw111pbel relied(including <br /> by the County of Burnett WlscoIng lnsin in determin ngcwhether toisrecognize a permit. ", \ t2 in <br /> $w v b <br /> further accept all liability that may be a result of the County of Bur <br /> relying on this information I am providing in this w a o0 0 o o 'y <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have o C w o o w w n <br /> �I ^ m > > .3 <br /> access to the above-described premie at any reasonable me for the purpose of Inspection. c <br /> OWNER'S SIGNATURE (date) o'F o S o <br /> ZONING ADMINISTRATOR <br /> c C1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N 8 0 8 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �0� l�i�/It)(/ <br />