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C ^ O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 3, �J <br /> APPLICATION FOR LAND USE PERMITS o 4Z <br /> OWNER- ,1/A ��� O rn 1 /� TELEPHONE �j�� CI/, /� GJ� C)� = o J <br /> J/ d / 7 <br /> MAILING ADDRESS 7 / L ��� <br /> l/V �L pfd <br /> PROPERTY ADDRESS TJ A— C v�- n <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE ❑ CG <br /> BUNKHOUSE ❑ 59.692(SV)GAZEBO ❑ STAIRS 0 FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: )r<L <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) YJJAI <br /> BUILDING CONTRACTOR: <br /> o < <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � <br /> 1. 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 tyf 'O ^ 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o N J <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK J I <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p r\ <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES p <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHENQ- <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: m G G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i z O <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 _I= <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. T 'ro > ono nnb <br /> Ig n 3 3 ^ a = 77 <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m ^ $° <br /> PP ( 9 Y ) Y Y g o ,2 � <br /> knowledge and belief it Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all <br /> information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this c =.> > m <br /> providing will be relied u <br /> information 1 am g upon by the County of Burnett Wisconsin In determining whether to issue a permit. I. Ef — <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 ^ ;�, ,°z o o -08 <br /> „r"„ <br /> accessto the above-described premise at any reasonable time far the ose of Inspection. o 0 „ o o a <br /> to w , aawtiWn <br /> 3 'i7 ^ ycoogo y <br /> OWNER'S SIGNATURE , 2C�i f " f�i J�7�//// a <br /> �y} C /� y� (date) <br /> ZONING ADMINISTRATOR jan <br /> TOWNSHIP PERMITS MAY BE REQUIRED a °° <br /> THIS PERMIT SHALL EXPIRE,ONE YEAR FROM DATE OF ISSUANCE « a <br /> to N O O O O O <br /> berm l e f1 ei p rcked vp <br />