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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 /> a <br /> OWNER Tm i Na tick L.IL.n/f TELEPHONE &,!�/,� <br /> V O <br /> MAILING ADDRESS /03105r C14 Np2 Ayq. St°- PA t, N. r -1 UZ-- J 3 <br /> 1. , <br /> PROPERTY ADDRESS a fa/ �� � �' � <br /> Y� o <br /> LEGAL DESCRIPTION Q 1� dd 1 4 1 <br /> TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK,-21 STRUCTURE ❑ R. <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ b <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S <br /> STRUCTURE/ADDITION USE: G�` ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: D W R1 LR— <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. '� a <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �% <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW n' o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, N c <br /> AND INDICATE NORTH(N). O > z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) Oc> <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O (5 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. 1 5 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES (ytl� <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. qj <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 I~ <br /> NEEDED. <br /> ((^^ 1 <br /> THIS PERMIT IS SUBJECT 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. <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 /> 2 3 3 3 c 0 <br /> n <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I 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 rn EL a Da m 2 > <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I d P. <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this c <br /> application. I agree to permit cou officials charged with administ g county ordinances or other authorized person to <br /> have access to the above-0escribe miser at any r so ble i he purpose of inspection. ° R > i <br /> �— 2 �, 9 S0000d <br /> OWNER'S SIGNATURE 1[. � a g <br /> (date) <br /> ZONING ADMINISTRATOR 2 <br /> JUL 12 <br /> TOWNSHIP PERMITS MAY BE REQUIRED h <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAMMNETT COUN g <br /> ZONING <br /> 0000 � <br />