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C O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERI/D'V4Lp t- �i4 A/D(Z,4 �/ZIG M7TELEPHONE 7�S- 25_c�'3Oyy d <br /> MAILING ADDRESS n <br /> PROPERTY ADDRESS <br /> S,4 „tffG 7 <br /> LEGAL DESCRIPTION <br /> 1-0 1 <br /> V <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 /> 'o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o <br /> STRUCTURE/ADDITION USE: 6 5TO AaC— L C c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; c.) n ,4 <br /> BUILDING CONTRACTOR: n O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C c <br /> WILL BE RETURNED. S <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ' <br /> BUILDINGS/STRUCTURES (NE),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES, (B)BUILDING(S) e <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. O J <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES l� <br /> ,0 BUILDINGS, ROADS,LAKE, LOT LINES. w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �a <br /> 6. IF SEPARATE PLANS ARE SUBMIrrED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE p� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. cam- N <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ...1 y <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 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. I (^ <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> ;0 <br /> 7. o 0 o Dt77 <br /> R " 3 3 3 $ ts1 <br /> � Z <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my o Z ;,.., .,, ? w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m P <br /> information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this " e > n m ,�,: Y <br /> information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I $ n ?w v: `a <br /> further accept all Ilabiltty that m be a result of the County of Burnett retying on this Information I am providing In this <br /> application. I agree to Penn u officials charged with administrating county ordinances or other authorized person to have " c 8: 8 ► <br /> access to the above-descrlb pre Ises a ny reasonable time for the urpose of Inspection. to �, g a aw„�, w a <br /> OWNER'S SIGNATOR na o W n a G <br /> (date) 2 Z <br /> ZONING ADMINISTRATOR IVYI <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> p m �� + lP�� 0(C_k' ��o b� �analdl lJr!jh� �� s000s <br /> qI/s--66 <br />