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e Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator < / �, P <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERQ e- SA SSF TT— TELEPHONE 6/3 5 - 3.78 J o <br /> r�nn J <br /> MAILING ADDRESS <br /> /Y+,� V .J <br /> ALI <br /> PROPERTY ADDRESS \ <br /> LEGAL DESCRIPTIONc Q <br /> .5 TY? IJ k yW 5-E SC Ash Tow. <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE 5? <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURED a <br /> STRUCTURE/ADDITION USE: o,-t ! 6ri - 6ar� '� InwQ* z <br /> (Home/Cabin; Commercial Business; Bedroom; D ; etc.) <br /> BUILDING CONTRACTOR: Z 7 t f n <br /> 0 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> ry <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ^p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. h n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW tea B <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH (N). N o <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 5 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES S. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. S. m <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 <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r w <br /> 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z rel <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. A I <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. 0 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Q <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7, >0 0 o pnpb <br /> g <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0� � � � w' <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 `-. > a m ;$ !, <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I E 5 ,��, a w > <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this c w H '_^N 'e <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have '0 n o o 8 o n <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. °� w a a '^ <br /> w <br /> 3 m Dgg <br /> OWNER'S SIGNATURE 'r �L ^ �' >' m n O <br /> �� > = � m p <br /> (date) Ow 1oil <br /> ZONING ADMINISTRATOR s n <br /> n C :' rim <br /> TOWNSHIP PERMITS MAY BE REQUIRED G °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE »=H: � `— <br />