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e n Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 3 ° <br /> APPLICATION FOR LAND USE PERMITS <br /> ° <br /> OWNER ��O sTELEPHONE� ,rN r10� o(?A AAL)ds <br /> MAILING ADDRESS / NtR,4 / p /6 V A ///cy-S/6/61)8 I dvcL <br /> sJ <br /> PROPERTY ADDRESSSS/a y <br /> o79 �lvd , C�� /� � DAtJ �uRy l.�,S ✓� `/b30 0 <br /> LEGAL DESCRIPTION o_ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT 0 , <br /> o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; ommercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: /7 n \ <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN B yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. n <br /> n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. K O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW M ' <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, C ? Q <br /> AND INDICATE NORTH(N). N I o I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) $ O <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK i I <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 q I O <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. = ti <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 /> PIANS MUST BE SIGNED AND DATED BY THE OWNER. o [� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN -a I <br /> NEEDED. IlSU <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: h 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS.OF PERMIT. n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 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 . <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 /> ^ gda��tl a ro � <br /> 7. ^ n $ 3 3 3 <br /> zo9Et <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my o ,Z d.R.3.e <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all EL m d $ y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this a n a^ n a=: a <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I 2 P ao < b <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 c H N"'t,N .0 <br /> application. I agree to permit coup Is charged with administrating countyordinances or other authorized person to have ^ <br /> access to the above-described Ises y ma able ti a for the purpose f inspection. O U$g a <br /> OWNER'S SIGNATURE (date) o " a o mn 6= Z <br /> o t+1 <br /> ZONING ADMINISTRATOR ''" ' 'M <br /> 9 <br /> w <br /> TOWNSHIP PERMITS MAY BE REQUIRED O «H H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �LY ml i J-1 e+4-E(_ fhA 1C-d 40 7YYl Q` q <br />