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z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> _ 11 APPLICATION FOR LAND USE PERMITS = - <br /> OWNERr,. lQ1)'1E1�'1^2,JELEPHONE SII r—Z 5CI - 3.77 1 <br /> MAILINsG ADDRESuS `\ <br /> I <br /> PROPERTY ADDRESS <br /> 30 <br /> LEGAL DESCRIPTION E - <br /> TYPE OF Peanrt(s): SINGLE-FAMILY DWELLING 11 ADDITION LI DECK GARAGE/ACCESSORY STRUCTURE 01 _ <br /> BUNKHOUSE 0 59.692(lV)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 { 'z <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: / 6 r'v'E`"1 Z <br /> (Hone/Cabin;COmmerdal Business; Be1droum;Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> z <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS v <br /> WILL BE RETURNED. <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 NEIN <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 1� <br /> AND INDICATE NORTH(N). R:-3 0 9, <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 00 m <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. SCJ <br /> 9. 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 BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <br /> 6, IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER, CONTRACTOR,ETC.,THE CJO 1 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. _ ) <br /> NOTE:� BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN orf ' <br /> NEEDED. � I t l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> � n <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q) <br /> 9. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY SMUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. , <br /> 6. <br /> ]. ., .T > nr. n ^ icjz <br /> ^ 3 3 3 A R <br /> 3 3 3 ? = A <br /> kdecLarenowled Oatthisisappiision(intlWit and compete.es any Iickzowlede)M1at been examinedbyfor <br /> ednd tathe accuraest of cy <br /> information <br /> and in thiugcarractanB complete. yaccom,eeE9etMtlam)a nd I enter eclareailaMacruracy of all ET > ce I <br /> information I am <br /> ngwill be relied(includinganyaccompanying Wiscole)and Itermerdeclareheroissue that I aermi I - - im1� Y <br /> further acc [am pmvilty Willa be aBopen of McCounty of BurnettWisconsin hisinfrmaiio w am providing iapermit [ _ _ <br /> further accept allliabilitytoo mat maybearewn of rg county of Burnettingco relying on or information oro1er authorized <br /> in this _ z — <br /> application. lagreempermi[wunry officials charged with aOminis[raHngwunryerdinancesoromeraumorixed person to <br /> have access to the above-Uesaribe remises at any reasonable time for the purpose of inspection. „ > <br /> n %, i Wry <br /> OWNER'S SIGNATURE �ZftulLZ 3 n Gj <br /> ZONING ADMINISTRATOR RU/ /� L/ <br /> t a = <br /> TOWNSHIP PERMITS MAY BE REQUIRED '- <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ff ffj r COUNT <br /> ZONING <br />