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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Once of Zoning Administrator o <br /> APPLI///C���ATION FOR LAND USE PERMITS <br /> OWNER 1 �O 7/ TELEPHONE <br /> (O _( <br /> 1 /��O 2986 <br /> m <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> Gi'ly��YX/ <br /> r / l /C� ' //Z/ //////���✓✓✓ < <br /> LEGAL DESCRIPTION L�/-, L//L <br /> TYPE OF PERMIT(S): SINGLLLLE-((FAMILY DWELLING ❑ ADDITION O DECK ❑ GA GE/ACCESSORY STRUCTURE ('(� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ `V <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o � <br /> STRUCTURE/ADDITION USE: <br /> (H9pa/Cabin; Comm Tal Business; Bedroom; Deck; etc. �n) <br /> BUILDING CONTRACTOR: �/.t_GI�O�v <br /> n <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C R <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW tN•f '° " o 5 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <br /> AND INDICATE NORTH (N). .z.� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o o Oy <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. cy <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES - Jj <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 Ju R <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. S6 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. .z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. Q <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. f <br /> 1 <br /> 7. ego El E6 <br /> A � dEl� <br /> n n � 3 3 n <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m d rn y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this 5.9 9 m '° <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d ?R $ <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordin ces or other authorized person to have ° 2 <br /> access to the above-described premise t any reasonable timefor the rpose of ctlon. 9 t w w N Y <br /> OWNER'S SIGNATURE <br /> nfn Y ^' W nsy � Z <br /> C a 9 C G. <br /> ZONING ADMINISTRATO ECE5I' i? w ! =n TI <br /> TOWNSHIP PERMITS MAY BE REQUIR OCT 1 92012 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATI 0 ISSUANCE ti o N N o <br /> � � 00000 <br /> BURNETT COUNTY <br /> ZONING <br />