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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS m y <br /> OWNER / /J !�� /r TELEPHONE <br /> MAILING ADDRESS <br /> /6)97 / 64) &0 f2iehmori )12 511o/� <br /> PROPERTY ADDRESS a/J`f 1/ L/�D u / /L o <br /> Vr)13, leU T/ <br /> I <br /> LEGAL DESCRIPTION c p <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL AAD/DITI,OI� ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c `° <br /> STRUCTURE/ADDITION USE: J Le G" Z <br /> (Home/Cabin; Co ercoial Business; Bedroom; Deck; etc.) � <br /> S <br /> BUILDING CONTRACTOR: a <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. " d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW t� w3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Cn p <br /> AND INDICATE NORTH (N). I Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS) TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES Do- <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 £ C!J <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. W <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r. V.) <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. 8 p a <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 "I <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. f <br /> 7. > n ape <br /> xr333 �+ c.� p7 <br /> zoo � g ' � <br /> I declare that this application(Including any accompanying schedule)hes been examined by me and to the Desi of my 0 e ? w <br /> knowledge and belief It Is We,correct and complete. I acknowledge that I am responsible for the detall and accuracy of all .93 ,2 =m E <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this f° E. a a m N, <br /> Information I am providing will be relled upon by Me County of Burnett Wisconsin in determining whether to Issue a permit. I o $w={ 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this c <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises atareasonable for Me purpose of Inspection. m N N w n <br /> 341 y' 88o $ 8 „'a,3 <br /> OWNER'S SIGNATURE D a y, y c <br /> ( ate) o <br /> ZONING ADMINIST 0 r [ H v,= y ° � _n M <br /> and e n a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE »H <br /> p�r�i l e plied ttp b y Lary <br />