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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER (T t 11 SU �C-1 TELEPHONE Rc <br /> o J <br /> 'v1 J <br /> MAILING ADDRESS 83 99 J\ o <br /> oto/ �N (-ArogetASSallc L 9 <br /> PROPERTY ADDRESS --- Knf . <br /> o <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT ❑ <br /> rt �• <br /> COMMERCIAL BUILDING E3 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: Pti e rYY 4'ZX Q Z <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) a <br /> BUILDING CONTRACTOR: <br /> n <br /> � 3 <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. e, <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, a <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)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 J Rj <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES 0 Co <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE (f o JJ D <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 r VJ Q C.0 <br /> NEEDED. <br /> n O <br /> O � <br /> THIS PERMIT IS SUB]ECi TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n O <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. F <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER yl <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. c <br /> 6. £ O <br /> 6 <br /> 7. ^ qy annn G)a Oro <br /> R ? G 6 n ttJ <br /> I declare that this application(induding any accompanying schedule)has been examined by me and to the best of my 9 c ntlC <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m v_' ! y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that t recognize that this S.D a m `O <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 R R a w= <br /> Fj <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 have n o o o o <br /> access to the above-described premises at a reasona le time for the purpose of inspection. w N w (] <br /> OWNER'S SIGNATURE <br /> d, y� mn Hm0 <br /> _ - ^ (date) �y da 5 � � E <br /> ISTRTOR _ - <br /> ZONING ADMINo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEtR FRP DATE OF ISSUANCE N ti ti <br /> eclCConstrU,.chof, <br />