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C ° p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS N <br /> OWNER1 '{ G ` IJ V��r/1 �1�-) TELEPHONE `i/ S_ 6 3 s 610 3 o <br /> tt p <br /> MAILING ADDRESS a S 501 C/ d, <br /> ) <br /> PROPERTY ADDRESS WCM LCv,L \ (�,) � S C4/ g 3 (7 0 <br /> LEGAL DESCRIPTION _UTo <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ 1 DECK 0 GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT ❑ Cd <br /> ro <br /> COMMERCIAL BUILDING 01CO,.MnnMERCIAL ADDITION 0m �COMJ-M�ERRCI,AI(4�A,C,CE,SSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/C In; Commercial Business; Bedroom; Deck; etc.) Aw) P_fte?��- <br /> BUILDING CONTRACTOR: S�I <br /> � b <br /> o � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. Rc <br /> 'n <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 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEWO 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, C> o <br /> AND INDICATE NORTH (N). 0 0 0 <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 W <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. I O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES .9J a. 1 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. _r m <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rY� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. -F i <br /> ' I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ..I <br /> NEEDED. - <br /> THIS PERMIT IS SUBIECi TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. e <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 C) <br /> SETBACK AREA. '- <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Q <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. >0 0 0 n 0 r0 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all =c ^q <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this . e 9 a o7 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. [ w <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 have <br /> access to the above-described premises at any me able U purpose of Inspection. Y <br /> 3 27 a a ogoog y <br /> OWNER'S SIGNATURE <br /> '' ff <br /> ZONING ADMINISTRATOR V I�I/! E� .j <br /> TOWNSHIP PERMITS MAY BE REQUIRED SEP 20 UI <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANC <br /> BURNm ° 0000 <br /> ZM <br />