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c rt Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> 3 � <br /> OWNER l�ri (,'(J(J�a- TELEPHONE S� <br /> esi tag[_ 8016 d <br /> MAILING ADDRESS <br /> 3 -3�3 <br /> PROPERTY ADDRESS c5a d l <br /> LEGAL DESCRIPTION <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 /> ro <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDI,TION USE: sc-P (!F&) -I -: A z <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc. o <br /> BUILDING CONTRACTOR: <br /> O pc <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/3 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) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. K 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, .n <br /> AND INDICATE NORTH(N). N 'Y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B) BUILDING(S) 0 <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. C� <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES oG <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 .p <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. (},) <br /> a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN o <br /> NEEDED. <br /> � O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v C C' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. f0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. h Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BESED FOR HUMAN HABITATION. <br /> 6. M k_e,+ ]5 i `fr D.r-, $efo L' 4-qt-)L E <br /> 00 onn �l <br /> 7. <br /> � '46 . u n o 'o �. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge B 0 ,:2 0 B g ? <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information c, w = d d rn <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I c D <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit I further accept all O <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- ^ n,2 0 $ o <br /> described premises at any reasonable time for the purpose of inspection. <br /> W N L1 0 W N N 0 <br /> 1 - 6 9 0 0 0 $ 0 <br /> OWNER'S SIGNATURE <br /> (date) o <br /> ZONING ADMINISTRATOR <br /> � gy nC <br /> n � <br /> TOWNSHIP PERMITS MAY BE REQUIRED C °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O = N a <br /> ' " 80 888 <br />