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N b z <br /> a � <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <: <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER TELEPHONE�� <br /> - ct '�' �a.hG`,� y✓rL�G�''l C12_ s�f .5�✓/ Gt10' !�, <br /> O <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS tL) Rtts /_Lc /� D l �s i !V•S 0 1 <br /> ° <br /> LEGAL DESCRIPTIONI( ,,, ° <br /> PcL �, �J3 G�t�ts /ye�i` ©�) �� �r/��zYTe ��� <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITIO ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ ?. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> •o <br /> COMMERCIAL BUILDING ❑ OMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> z <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial siness; Bedroom; Deck; etc.) � <br /> BUILDING CONTRACTOR: [nlr c-/"g 1� ' r) <br /> O 4 — <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> rn <br /> r7 a <br /> d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c, m <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 NEW d .� o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, 1 c <br /> AND INDICATE NORTH(N). C�) own z <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. 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. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS To BE GRADED OR FILLED. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE _I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. (w},I31) <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. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i ;c <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. /(e j dwell lig to ba &Closer tkwh 4A& W-Jkvt 5c46AX as C61&04kQ syr�+raCltCowfy�unl� <br /> 7. > o 0 o Oa0 "tl <br /> m � aftn <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 <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I Y <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 ordinances or other authorized person to 2° <br /> have access to the above-described premises at any reasonabl time for the purpose of inspection. m > w'4 w O <br /> OWNER'S SIGNATURE A 6 0 o S o 0 0 <br /> (date) y� >,2 3 O <br /> ZONING ADMINISTRATOR t Z A. 25 k, AV12e <br /> TOW HIP PERMWS MAY BE REQUIRED y <br /> c w ; <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM/p ATE OF ISSUANCE S <br /> jf «� <br /> ` / CJ�Ccas� r 7C/' , N U o o <br /> G+-tv �ljre�. tit 0000 � <br />