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e o <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> n <br /> OWNER TELEPHONE d <br /> :LING ADDRESS W5*5 L M9g0cMV*, 'D' yLG i)Meh)Yt MN1 5612-'� r <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDMOiP<QDECK❑ GARAGE/ACCESSORY STRUCTURE ❑ v, 4 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE ❑ ro <br /> A.� [� _ <br /> STRUCTURE/ADDITION USE: ��� Pe V/ovl ✓M 4K�b ( <br /> a <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �V ST12Jc._ 0►.l S�I,CS . W <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Q <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, r p <br /> AND INDICATE NORTH (N). N 'Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) ° <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. tc <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES , m <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 /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE J <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y 1 J <br /> NEEDED. — y <br /> � O <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: r- G <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. �1 <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. NOT TO E USED FOR HUMAN HASITATI <br /> . <br /> 7. a�rl !� xla nnp��ea� <br /> z R 25 <br /> t declare that this application(including any accompanying schedule)has been examined M me and m the beg of my o , � � �$ 5?• � <br /> knowledge and belkf It Is true,m. and complete. I acknowledge MN I am respoi ble for the detail and accuracy of all <br /> Information contained In this application(including any accompanying sdmxkde)and I f xthr declare that I recognize that this <br /> Information I sm providing will be relied upon by the County of Bumett Wisconsin In determining whether tD Issue a permit. I <br /> further accept all liability that may be a result of the County of Bunrnett relying an Mkp knformatlon I am prwAdIng In thisCr n N <br /> permitapplication. I agree to permit county ofMdals charged with admlNsitatlrg county ordinances or Ww authorized person co have 4 "' ' <br /> amen to the above-described premises at any reasonable Mne for the purpose of I ^ $$8 c 8 <br /> OWNER'S SIGNATU MR: <br /> to <br /> m m <br /> O H aC' G <br /> CC ! 6 009 . 6'€ <br /> .QNG ADMINISTRATOR y w <br /> 9 <br /> TOW PERMITS MAY BE QUIRED BJRNETT COUNTY <br /> THTS PFRMTT SHAI PTRF f)NF VFA FROM T)ATF OF TSSI I�hHNG <br /> 7,v �r�stCdnS c�ch�h.serv,ccr/o 9-6 <br />