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b z <br /> _ � o <br /> 6 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3' <br /> APPLICATION FOR LAND USE PERMITS <br /> nOWNERUN /NTELEPHONE Gil- 6/// a <br /> -77,9 d <br /> _ _ - Ul 3 <br /> MAILING ADDRESS // 7� 7 (�j /, n'/y��/������ <br /> -717 / n /VC/ V <br /> PROPERTY ADDRESS QVC)Sj °tZAl/ /all rZ11U <br /> v < <br /> LEGAL DESCRIPTION Jf ° <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK❑ GARAG ACCESSORYUCTURE�} 2 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 c <br /> COMMERCIAL BUILDING 0 COMzM�ERCIAL ADDITIONN D COMMERCIAL ACCESSORY STRUCTURED S <br /> STRUCTURE/ADDITION USE: qdX' "-, Z� X V( / UJ <br /> (Home/Cabin;�Commercial Business; Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, N 1 a <br /> AND INDICATE NORTH(N). O o Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) Q3 ° <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O <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. U. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE i <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. } <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBIECi TO ALL CONDITIONS LISTED BELOW: J x <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. wV <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER G <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 /> 7. > > o 0 0 c O b <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 <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 f° 5. D E 'O <br /> information I am providing will be relied u ' a <br /> p g upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liabilitythat 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 admini ing county ordinances or other authorized person to m = o o o [" <br /> have access to the above premi a reaso le ti for the purpose of inspection. m c c c o a <br /> OWNER'S SIGNATUREAM <br /> o <br /> ((= a <br /> (date) Lro <br /> ZONING ADMINISTRATOR o as .zl <br /> OWNSHIP PERMITS MAY BE REQUIRED 6 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANWINETT COUNT <br /> ZONING to 11 <br /> J NO u 1 O <br /> 00 p 00 <br />