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e Z <br /> 6 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator :5. <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER1 1r.1„1i„115 5 ri �Q"r TELEPHONE &S� <br /> I✓� s <br /> O <br /> MAILING ADDRESS NIiii Dearborn <br /> Pa-I hasernb"fi mrd 5-&-t`168 ; <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION 1/f, ilIQ q e Of- Ye"o u-) L0.L-e�f to-l— 15 51O�_K /to <br /> S <br /> TYPE OF PERMIT(S): SINGLE-F ILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED <br /> /lJ� yl ✓� OO ° <br /> STRUCTURE/ADDITION USE: Rb(YtC <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. o. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C O <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 C <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, N I <br /> AND INDICATE NORTH(N). CD o 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 O <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. pi <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 5. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. xs--: <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. <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 111 <br /> NEEDED. p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. I d Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y '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 g ¶vim <br /> SETBACK AREA. O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. `< <br /> 6. <br /> � annnna e <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0,°Z 9o 01 o. w <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all �, m � L <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this `9 E. a W N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I d ? c n 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 g, <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to :° n != : o; 8 o ,r, <br /> have access to the above-described premises at any re bile time r the purpose of Inspection. W A c N o coo a <br /> OWNER'S SIGNATUR - <br /> nn 6 <br /> (date) U, LqbLPHV 2 m n d= 2 <br /> ZONING ADMINISTRATORIry <br /> . <br /> y : � w o G1 [=1 <br /> 102012 aM <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAcot <br /> �a <br /> ZONA �No�U8o <br /> 80 <br />