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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS 7 <br /> 4 <br /> OWNER TELEPHONE <br /> iY)n K 'F ut. fp' ro', <br /> � <br /> MAILING ADDRESS O <br /> a�3 a 0--'3 � id� Qscrc, (a , w 1 SNb <br /> PROPERTY ADDRESS '�J73 'T 14nrhor Ton ece (.Jeb5fr 1,:1 <br /> LEGAL DESCRIPTION 7� <br /> e c- S T I /,5- (til <br /> TYPE of PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECKX GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> STRUCTURE/ADDITION USE: ��,d b..r... J.�� z �{ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ° <br /> BUILDING CONTRACTOR: Igow e n u3ny C n <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS ;o o <br /> WILL BE RETURNED. _ H <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, _ l <br /> AND INDICATE NORTH (N). c c <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. O <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 /> 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 r <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. V 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN t <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Dq <br /> („ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z 111�33> <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. U ,� <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. Vll <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. gy > aro <br /> 6 m <br /> � 333 �' 6 <br /> [declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 p <br /> knowledge and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all B ' d d a y <br /> Information contained In this application (Including any accompanying schedule)and I further declare that I recognize that this a E. D m `o <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I v ? ' 'n SE <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this d ' ✓n ` y <br /> . <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to L) 5 E <br /> have access to the above-described premises at any reasonable time for the purpose of Inspection. > w N w A <br /> to <br /> OWNER'S SIGNATURE L--//r't'w�' — y�/ /�(� 3 A 0 0 0 0 o y <br /> A 6 M <br /> -Ian, (date) <br /> n � >� <br /> ZONING ADMINISTRATOR ' o o S :�' S�° <br /> _ L1 ff7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED D; E L M <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C o <br /> r)qA,t14 Off �7(,+ d:M BOW4e ✓ q <br /> � � a0000 <br />