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z <br /> 3 <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator - <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE ?_ <br /> MAILING ADDRESSICD <br /> PROPERTY ADDRESS n <br /> 7 cJ, fs£rPo <br /> LEGAL DESCRIPTION naq 7'god Rlelj h?J o7-a;:ft-„t-40-%Y-JY-S a <br /> _, G cJ� 4TE r-vvr-oih000 <br /> TYPE OF PERMITS): SINGLE-FAMILY DWELLING❑ ADDITION U DECK❑ GARAGE/ACCESSORY STRUCTURE.j _ <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS❑ FIWNG/GRADING❑ CAMPING UNIT❑ a <br /> r <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ITCOMhpp)ERCIAL ACCESSORY STRUCTURE 11STRUCTURE/ADDITION USE: PrI VG(,1'eU 3a lYgL I� <br /> (Home/Cabin; Commerdal Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR:�Y-Z.J r - SAF <br /> A < 9- <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS r <br /> WILL BE RETURNED. <br /> r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW Q o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, , <br /> AND INDICATE NORTH(N). <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. S-) <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES O <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. �N <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. II IwoSi <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE -C a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION NYSE DONE WHEN <br /> NEEDED. Hyl x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1' a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. UE L z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, O N <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. v <br /> NOT TO BE USED FOR HUMAN HABITATION. S <br /> 6. <br /> ]. ^ p; > nnno > <br /> m <br /> I declare that this application(including an F ^ ^ 3 3 3 <br /> any acknowlede) hatbeen responsible <br /> the deaMed accuracy <br /> knowledgea contained <br /> it in thistrue,direct nn(icomplete. y acknowledge sctl ule)and Ifurt further <br /> that <br /> tIreccuraq that <br /> information mnrainetl in this application(including any accompanying schedule)andlfurther declare[M1atlrecognize that this _> > cti <br /> information I am providing will M relied upon by the Caunty of Burnett Wisconsin in determining whether to Issue a permit I c,c- = > <br /> Further accept all lishility that may be a result of the County of Burnett relying on this Information l am providing In this <br /> application. I agree to permit county officials charged with administmbng county ordinances or other authorized person to _ n_” . 8r <br /> have access to the above-described pramises at any reasonable time in In r sof Inspection. t <br /> OWNER'S SIGNATURE / .-- D '.W?Z S. I . <br /> oco <br /> (date c <br /> ZONING ADMINISTRATOmYI—HTE v�a-, <br /> -O <br /> -m sH; <br /> OWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISW�TT couhur y w ^ <br /> ZONING <br /> 4 o 0 <br />