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e z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator < o <br /> APPLICATION FOR LAND USE PERMITS y. <br /> ° <br /> a <br /> OWNERTELEPHONE O <br /> )< J Wei ,4 re2LE- G <br /> / o <br /> MAILING ADDRESS ^� Q y Ot0,� `5 / � I�) W 415 rQ <br /> r s <br /> PROPERTY ADDRESS O (-4 Sq Vvt `-I <br /> I O <br /> LEGAL DESCRIPTION , lr1 y)n I V/ L/ a�A- d 93 S <br /> fJ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION ❑ DECK❑ G E/ACCESSORY STRUCTURE �, _1 <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S '� <br /> STRUCTURE/ADDITION USE: c � <br /> (Home/Cabin;Commerd usiness; Bedro ; Deck; etc.) S <br /> BUILDING CONTRACTOR: io�Pel ti <br /> O � <br /> A c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. a <br /> n , <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c(S <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). c a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) R. ° 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. - q) <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. <br /> S. 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 Vy <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I , <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 1 W CI <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CA <br /> C <br /> d r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'p W <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 G <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. > 0 00 a0 - <br /> 3Ej E3 3 j <br /> A H 3 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 p no A � <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all y m m 'm. <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this D W 'O <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I �+ c > a 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 'moo mss N <br /> application. I agree to permit ce fficb" charged with administrating county ordinances or other authorized person to rn n w c o c P <br /> have access to the above-descri ed miles a ny r asonable time for the purpose of inspection. w N n <br /> o n o 0 9 <br /> OWNER'S SIGNATURE Y <br /> ., <br /> (date) yi a o = O <br /> ZONING ADMINISTRATOR ' n- <br /> .°� <br /> TOWNS P PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g. <br /> � � 000 oo <br />