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C A Q <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator g 3 UJ <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER JL(-Om,e1.C��lYJ,�{�OC��!✓1 TELEPHONE o <br /> O <br /> MAILING ADDRESS =-(-✓I Y],Q /-ar�� .. ate,/ �I GJ /O � _ r <br /> PROPERTY ADDRESS <br /> < Q 1 <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE D S9.692(IV)GAZEBO ❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT O <br /> r <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL <br /> /ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: a lea! <br /> . c ✓ �(am- l�Ir vCC #c') � p o <br /> . (Home/Cabin; merclal Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS S o w <br /> WILL BE RETURNED. <br /> _n <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. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) W <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w' d <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. rv�l <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES - t <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. 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 /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> I 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (J J <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: r C Q <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. <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIV RESIDENTIAL GARAGE/STORAGE ONLY\ <br /> NOT TO BE USED FOR HUMAN HABITATION. ScthA-elC rO loen A'} l e-c-d— \ F <br /> V 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my a,°� $?w' <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a Fgk <br /> a m n a y <br /> Information contained In this application(including any ac=mpanying schedule)and I further declare that I recognize that this " m,E;information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I 8 E—?further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this °o_ =N�'_'N roapplkatlon. 1 agree to permit coon officials charged with administrating runty ordinances or other authorized person to have $: $access to.the above-described p s at any reasonable time for the purpose of inspection. - m A w N w <br /> n <br /> �8$o88y-] <br /> OWNER'S SIGNATURE <br /> nyao= gsBZ <br /> (date) <br /> ZONING ADMINISTRATO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE « <br /> N N O O p O$ <br /> pu(n + + le++cir pitted h ����( KOc?✓IQY1� <br /> /,Nr koerl� l rr sofbnolc la 6e �Q r rrvn �_14 o / <br /> J/ sI It y7 fStaKes <br /> uacl yl { 0 W� �I 5� <br />