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j Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> Trn APPLICATION FOR LAND USE PERMITS r <br /> OWNER .+�/1��/yl/>� _ <br /> TELEPHONE [-^ 2 <br /> MAILING ADDRESS J J <br /> g6e7 whi,5'j2l/o/' L-h HHtZPl6re&hWZ53S/1 "� l <br /> I <br /> PROPERTY ADDRESS SoI5-1 / 1n_ rUQ /�d <br /> III <br /> i ^ <br /> I <br /> LEGAL DESCRIPTION <br /> 1-01 <br /> "3p• <br /> TYPE OF PERMrT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ (DJECK ❑ NGARAGE/ACCESSORY STRUCTURE ❑ ( m <br /> BUNKHOUSE 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMEERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 �_ \ <br /> STRUCTURE/ADDITION USE: LCY) Y l�1 U>� ( z G <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN B 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS z c � <br /> WILL BE RETURNED. _ <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 Y� <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, a ? <br /> AND INDICATE NORTH (N). <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 <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 - !� <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 <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. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Imo- <br /> L^ W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r� Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 00 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. > > ro <br /> 2 3 3 3 m d <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0,6 a °a m5 <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 contalned In this application(Including any accompanying schedule)and I further declare that I recognize that this 5. > > <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permlt. I Y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this T r "' ;�,w .`�1^ '„' <br /> application. I agree to perms o cl s charged with administrating county ordinances or other authorized person to have ^ 8 'oo' : Q 8 [' <br /> access to the above-desul d premise y reasonable time for the purpose of Inspection. x d w w W n <br /> �( Q.C`� 3 A y 'g - BH <br /> OWNER'S SIGNATU v ' O > o^ T O <br /> (date) a Z <br /> ZONING ADMINISTRATOR T 9 <br /> TOWNSHIP PERMITS MAY BE REQUIRED a ° <br /> THIS PERMIT SHALL EXPIRE ONF YEAR FROM DATE OF ISSUANCE ^ <br /> O _C G <br /> K�e✓m i+ Ce +e✓ rn��(emsTm l fr�rde� H a�-off <br />