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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 1` <br /> APPLICATION FOR LAND USE PERMITS z H <br /> OWNE {Je.P'f TELEPHONE /ova d <br /> MAILING ADDRESS n n <br /> /O/S ///.Q!1/ 1 //� Sf- St• /'/SHL — n"1/V <br /> PROPERTY ADDRESS, <br /> LEGAL DESCRI PTIOV VZ NW <br /> -c�L 1554 <br /> 15 1101 <br /> o Q <br /> TYPE OF PERMIT(S): SINGLE-FAMIILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE liQ <br /> BUNKHOUSE D 59.692(1V)GAZEBO D STAIRS D FILLING/GRADING D CAMPING UNIT D \ <br /> a <br /> COMMERCIAL BUILDING D COMMERCIAL ADDITION D COMMERCIAL ACCESSORY STRUCTURE D c `° <br /> STRUCTURE/ADDITION USE: -Sf0' q e z <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 1c ./ ca i Ce".5 f J <br /> r) 01) <br /> O � � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C c C <br /> WILL BE RETURNED. <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) U <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ,rte c7 <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, <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES q W <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 W <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 .j <br /> NEEDED. j O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C� 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. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER J <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 /> ^ pyDoor]� D 7 <br /> ], <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 41 E B P <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a m °= 2L '= <br /> Information contained in this application(Including any accompanying schedule)and I further declare that 1 recognize that this o e. > a m N <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this v v,w— '_^n 7 <br /> application. 1 agree to permit coun officials charged with administrating county ordinances or other authorized person to have " n o 'o g o ► <br /> access to the above-described se t any reasonable time for the purpose of Inspection. " a D 8 <br /> g o <br /> OWNER'S SIGNATURE S "f a <br /> (data) o a > s X . <br /> ZONING ADMINISTRATOR <br /> C n i 71 <br /> d <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> CI-)S �S �Q <br /> v� 614- i- Le+WjotC_o'A �� b� 3/Re�( �r �r 4 00008 <br />