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P (n <br /> � z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS N t I (YViy� <br /> p 6 ^^ <br /> OWNER Q��hG11 I TELEPHONE 115 <br /> _ lV,^ lam <br /> 3 /, Vll <br /> MAILING ADDRESS CT 1 <br /> PROPERTY ADDRESS n <br /> 0 <br /> 5� 1 SA , f� W h . 7- <br /> LEGAL DESCRIPTION i' w i S S �1� T(„I ' U I PCL 5 E N E USC b o�l to <br /> J cl '` c <br /> TYPE OF PERMTT(5): SINGLE-FAMILY DWELLING N ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE❑ <br /> c <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ r- S <br /> 0 <br /> z <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ .� <br /> STRUCTURE/ADDITION USE: RQ IN, <br /> ome in; ommeraa usiness; room; Deck; etc.) <br /> n <br /> BUILDING CONTRACTOR: r 1 <br /> O � <br /> � c <br /> c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAITS <br /> WILL BE RETURNED. Kt <br /> Aw <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C <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 p c <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, m S <br /> AND INDICATE NORTH(N). O o <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 LA) <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. i y <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. c <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> poll <br /> Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 'x <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, cC7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. T <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 4-- <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> �O > n o o m c O b <br /> nR 3 3 3 c <br /> 7. xz o ' 3 3^ o <br /> no c <br /> t <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all w a c n n <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this Z_'2: <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ,, n io o 'V <br /> r <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 m A > v.`„^, <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. a g o ,�_-, <br /> OWNER'S SIGNATURErM%Jwf'16iiinOn r% o A D'Z m n U �' m 2 <br /> o ; s? , a1 <br /> ZONING ADMINISTRATOR <br /> MA - ' <br /> OWNSHIP PEW"ITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS 11AUCE.ET P COUNTY <br /> tSUtiIIVV is e <br /> Yi�N U W✓+ � <br /> to tNii x 0 0 0 0 <br /> ZONING <br />