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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 <br /> OWNER ,rICK £ IU/-lA.i.ti I"1QJ.`fC� TELEPHON � ZS �I yZi2, <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> !7^���F� <br /> LEGAL DESCRIPTION r o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE r <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT ❑ <br /> v <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: o \ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) -F-- <br /> BUILDING CONTRACTOR: MeA Do � /J � n <br /> m � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS S o <br /> h _ <br /> WILL BE RETURNED. C <br /> f; a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, P <br /> AND INDICATE NORTH (N). N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 7 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK B <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 q <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. / „1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN d <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z C� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C \� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. T <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. t(� <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. _ <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. NuM be min ()f Iu'*,g(n no+-g) lcvf Brie- dL4o(+) f,-ofn rear Ic1 lig . <br /> 7. Lots q7 ,4q3 (,CI'Z �0hS1 of, ^ p7 aao ^e <br /> G PG( 1�2 l � g Eia °spa <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 belle(It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m d d w c, : -q <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that thisa > a m "' > <br /> Information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I , <br /> further accept all liability that 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 administrating county ordinances or other authorized person to haveo o o g r <br /> access to the above-described premi nable time for the purpose of Inspection. S n <br /> 3 'i7 m nO000 �f <br /> OWNER'S SIGNATURE �~2� >'±' cu n cD O <br /> (date) r a > > P3 R = Z <br /> ZONING ADMINISTRATOR <br /> c : w�atn <br /> TOWNSHIP PER ITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> U U <br /> tJA tNn O O O O O <br />