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N b z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITSN <br /> O `r <br /> OWNER Q� C �e�V.S TELEPHONE—7 <br /> 116 (), 707'1 <br /> /- d <br /> MAILING ADDRESS /Qvo cw It S.5 L�\Otf'e-,- c/I <br /> R / VjT) v <br /> PROPERTY ADDRESS S J <br /> LEGAL DESCRIPTION �� o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DEO1K ❑ GARAGE/ACCESSORY STRUCTURE ❑ v, <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: P,ka, lA _ 1")­r'- <br /> (Home/Cabin; <br /> ")rY(Home/Cabin; Co me cial Business; Bedroom; Deck; etc.) Lj <br /> BUILDING CONTRACTOR: S64 P-- <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c_ <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). o Ri 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 w' d <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. n �, <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. X� <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. � I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I-. <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. a <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. <br /> 7. TX r>+ o oon > <br /> 333So �. � <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 E ' m �; w 9. rn <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this f° __. > > m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I m �:c c a= > <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <. 'yo 3I En N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to n C1 m ^' : g o r" <br /> have access to the above-de-scribedpremises a any reasonable time for the purpose of inspection. > $u w n <br /> OWNER'S SIGNATURE__ , `^-T/' -��Y �"�' �'�U 3 9 �° o g o 8 o „'9� <br /> 0 <br /> T � (date) <br /> ZONING ADMINISTRATOR <br /> '�j ow. a� t�sl <br /> TOWNSHIP PERMITS MAY BE REQUIRED y <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ? g <br />