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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PM ITS <br /> OWNERlOrma 7 <br /> 3I//l TELEPHONE <br /> S- <br /> 0 <br /> MAILING ADDRESS f2rl Orb/ / L-i7 �'1.6V) y hr)bA_ if a-{ <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION r <br /> 0 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE r_ r <br /> BUNKHOUSE ❑ 59.692(SV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT O CO <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADQITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 a b <br /> STRUCTURE/ADDITION USE: rGL_ L7 l h Z <br /> (Home/Cabin; Celmmercial Business; Bedroom; Deck; etc.) ^C <br /> BUILDING CONTRACTOR: U}1 <br /> n <br /> p 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 '/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) rs <br /> I. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW M w <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, E 3 <br /> AND INDICATE NORTH(N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p <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. <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 Ota <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. o r..l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. R z <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 /> 7• m ono 0o >V <br /> ny333 ?�m � <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my g o,°� a F S w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m 4 <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this q a D m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d a p w= Y <br /> a— <br /> further accept all liability that may be a result of Me County of Burnett relying on this information I am providing In this v 0 in»"'—^N 7 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-desWbed premises at any reasonable r for the purpose of Inspection. a o 0 0 0 8 ➢ <br /> OWNER'S SIGNATURE r)/6O o Z m a a <br /> � mn <br /> o e <br /> ZONING ADMINISTRATOR IQn H C H d <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE «» <br /> � 00000S <br /> fie,✓mit � 1�-1-� �r�>� ec�u� ,6�� C��y �aasc� to-a9-o� <br />