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H e Z <br /> o <br /> 6 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator :: _' <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER TELEPHONE /-�jb'�- �9�8' O <br /> ��S na be IV <br /> o <br /> MAILING ADDRESS 1941 I eer A ' O J b r Ca n y)n I <br /> PROPERTY ADDRESS n,� ,( c — <br /> V (� l7 s <br /> LEGAL DESCRIPTION <br /> TYPE OF PERWT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE❑ a <br /> BUNKHOUSE 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S '� J <br /> Cz <br /> STRUCTURE/ADDITION USE: pL(„J G r� e- 9,J o <br /> ome a m; o mesa usl room; c • c. <br /> n <br /> BUILDING CONTRACTOR: ,g � <br /> O <br /> XI < <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS r t <br /> WILL BE RETURNED. o. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 p uc 3 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J Q T a <br /> AND INDICATE NORTH(N). D /f•/n o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) Ql S' V� <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. n� <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES I y , <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. y .[ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C 1 l� <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. ()' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. �' J <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: � <br /> p C) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. b <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. CJ I <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. ((�� <br /> NOT TO BE USED FOR HUMAN HABITATION. (y <br /> 6. <br /> 7. n > c o a w > 0 b <br /> 6 <br /> x n ^ 3 3 3 = _ � <br /> z _ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my g o . <br /> hat I am <br /> detail and accuracy of all <br /> reforknowledge <br /> Hon contained in this application c <br /> rrect including any accompanyinggt schedulead responsible further decelare that I recognize that this `0 ° > <br /> C Y ) p y <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 m a;7 dt of the County of Burnett relying on this Information I am providing in this `a N: o .0 <br /> application. I agree to perm un of(cials charged with administrating county ordinances or other authorized person to n = : <br /> have access to the above• -mu premises t any reasons pie for the purpose of inspection. 9 D S W N w f1 <br /> OWNER'S SIGNATU E /— A E o gg <br /> _ (date) n c? ci9 n C d M z <br /> 20NING ADMINISTRATOR "r /( �h = �O' FA r o n [-.I <br /> B C:" n C i a CzJ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE . <br /> Qpm-/t d- It+kr ma�L d 4D4-hna&t 6 3-11 <br />