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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS N = UI <br /> a <br /> OWNER ^ A % TELEPHONE <br /> (M:7 <br /> MAILING ADDRESS f. j C'0 <br /> PROPERTY ADDRESS S-/+Q-M (T <br /> LEGAL DESCRIPTION c ,� <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING Cl CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ a 9 <br /> STRUCTURE/ADDITION USE: S40 in �OX )& (.twd .Sk.( <br /> (Home/Cabin; Commercial Business;Bedroom; Deck; etc.) of W <br /> BUILDING CONTRACTOR: ^L r) cX <br /> O iNA PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o N (A <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. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW R7 ° 03 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O pp a <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) Q <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Q <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. , d <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES pJ 4 lt ' <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. , Jv <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE Cin \ o <br /> PLANS MUST BE SIGNED.AND DATED BY THE OWNER. i I ��l C>Q O' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. Csy <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C9 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. U,& V <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. O <br /> 6. (t)Obd eG( )+(dy AbE �UfeE (O' Side fat` Ir'{i+�aeh GTS �f - S, ,(x- &AC .COTS dry <br /> IMIACY $In� CMnKKhoa 1XW_ X t, (a2 Ynew IF S2()yTr Ove Ok/ <br /> 7. > 000naoro <br /> A � aFtn <br /> H R y 3 3 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 'o o S <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the d , <br /> detail and accuracy of all °' y 2, 2, m a H <br /> Inforrnatlon contained In this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <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 r,.,w?'=n ro <br /> applkation. [agree to per mk county als charged with administrating county ordinances or other authorized person to have ' �,°� o o : o o ,r, <br /> access to the above-descrbed pre at any reason me for o f Inspection. /)/ / 9 w ti W w,titA (� <br /> ' w�/`rCr �Cj 'O — f / A m = > wouo So „0 <br /> OWNER'S SIGNATU Wi m ' °' m � m m O <br /> n � aocmOd <br /> (date) �y S l.w r� n ¢ �= N �w <br /> ZONING ADMINISTRATOR " - nm <br /> n _ <br /> O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o U o <br /> e✓m� le ��er p?ted up 6q 6atile Na-e 01' 8-a -ll 0000 <br />