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' e <br /> z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g c <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER // TELEPHONE - d' <br /> 0 <br /> MAILING ADDRESS <br /> /L� Tt•IkinS S1• E�.S-/ 13e7�C/ , �H� .i`.So // <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> 07- OZy- 2-39-/y/•/L-J Oo=OU/- o//700 7C <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING D ADDITION D DECK D GARAGE/ACCESSORY STRUCTURE D <br /> BUNKHOUSE 0 59.692(1V)GAZEBO ❑ STAIRS 113-FILLING/GRADING ❑ CAMPING UNIT D a <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ /COMMERCIAL ACCESSORY STRUCTURE ❑ 2 <br /> STRUCTURE/ADDITION USE: LCI�LiAt� TO LIC I � z <br /> (Home/Cabin; Commercial Bu ness; Bedroom; Deck; etc.) T�^ ' <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yt X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS x <br /> WILL BE RETURNED. <br /> Tilly!__` <br /> n 2 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) he — t <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 n <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> o <br /> AND INDICATE NORTH (N). N c e133. SHOW DIMENSIONS 1N FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING($) <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. — Y <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. F-.-i r� o ;1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. L N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 11J=- <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 /> 1 dedare Nat this application Includin an accompanyingsched le has been examined b me and to Me best of m o 3 R $ <br /> Dp (Including Ye. u ) Y y <br /> knowledge and belle(It 5 true,correct and complete. 1 acknowledge Mat 1 am rend If further <br /> the detail and col of all F <br /> Information contained In this ill be ailed(Including any accompanying schedule)and 1 further declare that L rIssue ae Mat MIs $ = o <br /> Information 1 am pmvltllnq will be relied upon by Me County or Burnett Wisconsin In determining whether Issue a permll. 1 <br /> further accept all liability Met may be a result of the County of Burnett relying on this Informatlen I am pmvldlnq In this <br /> -- -a <br /> application. I agree to Permit county officials charged with administrating county ordinances or other auttented person to have <br /> access to the above-descHbed�ya a[any reasonable time for the purpose of Inspection. x L E_ ✓.w F <br /> OWNER'S SIGNATURE <br /> / LS� lJ l7 uLE — — _ O <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED AUG 9,2013 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS TE <br /> BURNETTCOUN <br /> ZONING <br />