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C rt Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS H y <br /> OWNER /'t Q r N Z f ' Lar CSI AC k a U_ TELEPHONE [ S / Y tP a 6!Ccp d <br /> MAILING ADDRESS I v 1 R y <br /> �n <br /> PROPERTY ADDRESS , /7� s --rl_ ��� /_ O1C eyQ Ge C) <br /> PL <br /> L I - 14Sem /_ / J? /1 1 - k / L/ <br /> `., ) o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ElDECK 0 GARAGE/ACCESSORYScTRRUCTURE v, <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ S" <br /> a <br /> COMMERCIAL BUILDING ❑(( COMMERCIAL ADrrDITION ❑ COM(yMERCI`AL ACCESSORY STRUCTURE ❑ r' ^ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; ComYnercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. .� <br /> � o <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. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW 'O 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, e <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 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. C7 <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o O\ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. X_J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> H <br /> NEEDED. 6 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n SJz <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. R p 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 Q <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. a 7g >r) a 'd <br /> `2 n n � 3 g B g'= <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 6 m d= P y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be railed 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 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have o o <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. „oa u.«l r1 <br /> �y p � aowwNwa y <br /> / 6/O �® / = na � � o8g <br /> OWNER'S SIGNATOR [] a A 6 o m n Oz <br /> �d ae bb <br /> (date) rn6 �__ 121 <br /> ZONING ADMINISTRATOR y ;ply w <br /> TOWNSHIP PERMITS MAY BE REQUIRED ( °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE « =N <br /> +gym d <br />