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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER <br /> TELEPHONE / a <br /> r <br /> V �7 QTR W' QrYn CJVS -'T/.S ���b ►�Jl� � s p� <br /> MAILING ADDRESS Po <br /> JC r v n <br /> PROPERTY ADDRESS <br /> OfseC- ionWY� Ne or <br /> ci� <br /> �,U tC <br /> LEGALDCa-K/?o e� 5 tIr <br /> Qtv- ! Lo+ Co -+ / <br /> o�flot: lr <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION W DECK 0 GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ C I <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE CIo S7 <br /> STRUCTURE/ADDITION USE: 1 bM�e b6l,(l O h z <br /> o <br /> (Home/Gobi � Commercial Business; Bedroom; Deck; etc.) _ <br /> 0 <br /> BUILDING CONTRACTOR: <br /> w )) C <br /> U1J2 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANSC 0 O <br /> WILL BE RETURNED. <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 O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, G a <br /> AND INDICATE NORTH (N). :z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) P <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 q Q) <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5 y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 1 J <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. (?h <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G ,� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z C) <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 70 <br /> SETBACK AREA. ` <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. d <br /> 6. &jd Mbr)`FD <br /> 7. � an000 'a m <br /> 6 <br /> 5 n <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 <br /> Information contained In this application(Including any accompanying schedule)and I further declare that 1 recognize Na[[his �-9 9 m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a perit. I d �.R >w' b <br /> further accept all liability that may be a result of the County of Burnett relying on Nm <br /> is 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 o o 8 0 .r. <br /> access to the above-described premises at any awn able time far Ne pu ose of Inspection. EW c o o o <br /> d m ; > <br /> OWNER'S SIGNATURE � <br /> (date) <br /> ZONING ADMINISTRATOR <br /> O: <br /> TOWNSHIP PERMITS MAY BE REQUIRED p °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a N <br /> So000 <br /> -li�m 1 �-4 142 1'--1-e-�'1�,�cP,, tD 60 vdoh HzErrron 'V-/l `/D " <br />