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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a � <br /> APPLICATION FOR LAND USE PERMITS <br /> l �/ _ 9 <br /> OWNER �P II(!✓ t} �I-(� C.31 GUI TELEPHONE 7I� l�O_ y _ d O <br /> MAILING ADDRESS A I <br /> �9y orP ✓Lr , X17 Iry 1,,L)T- <br /> �1$3n <br /> PROPERTY ADDRESS M n s + <br /> LEGAL DESCRIPTION `-�5 a(o d-a'7 , V I k_,'vt�( h,ll aM. 11-1,0.1 -}o vo Yety�, <br /> Jr Aj L o <br /> TYPE OF PE (S): SINGLE-FAMILY ELLING ❑ AD ITION DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ c� <br /> 5 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ S),S <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE OnV n C� 13�I) 1C, Iv l-c z <br /> (Home/Cabin; ComrAercial Business Bedroom; Deck; etc.) 54i4w <br /> BUILDING CONTRACTOR: O — r yi ev�l/1.50 <br /> n <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 hfi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. G w� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW tNlf 'O C9 0 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, e <br /> AND INDICATE NORTH (N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 , O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. t7 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES �.: 1 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. q 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 o �I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: NEEDEDG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y l <br /> r <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <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. B � <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. $ ' Dgagoo% aOW <br /> ' `K�° 33 � ^� M <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and bo the best of my 3 e °�� <br /> knowledge and belief It Is true,comet and complete. I acknowledge NN , <br /> at I am responsible for <br /> e detail and accuracy of all Z <br /> Information contained In this application(including any accompanying schedule)and I further declare that I remgnlze that this <br /> Information 1 am providing will be relled upon by the County of Burnett Wisconsin In de herminlnp whether to Issue l parrot. i n n w= <br /> further accept all liability that may be a result of the County of Burnet[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 " o g: $ 8 <br /> access to the above-described premises at any reasonable time for the p rpose of Inspection. S <br /> F3 � � 90 $ 008 tea] <br /> OWNER'S SIGNATUREF' <br /> � � aom�e� z <br /> ZONING ADMINISTRATORc 6 <br /> TOWNSHIP PERMITS MAY BE REQUIR JUN 172009 `�H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATEIlANCEC�NTM <br /> NETT � N80008 <br /> ZONING <br />