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C � O <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS 0 <br /> OWNER B( ^ 1 �'SA M. nn TELEPHONE C <br /> MAILING ADDRESS1 ,� � <br /> PROPERTY ADDRESS rl S ick 6 on Q Ive il�d <br /> o � <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIr(S): SINGLE-FAMILY DWELLIN ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ 5 <br /> BUNKHOUSE C 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ r <br /> o�- l/r +o r <br /> COMMERCIAL BUILDING ❑ COMMERCIAL El { <br /> L ADDITION COMMERCIAL ACCESSORY <br /> STRUCTURE ❑ W <br /> STRUCTURE/ADDITION USE: ' � — P6, �. r' qq3 I i� <br /> (Home/Cabin;Commenciai tsusmeSS; a room; eC ;etc.) <br /> Y <br /> BUILDING CONTRACTOR: Ick ZP W <br /> 0 <br /> rn <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 r/x X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAIIS <br /> WILL BE RETURNED. <br /> f7 m <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C w <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m N <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW i <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) G <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. C7 w <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. v o d <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. W d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CJ1 p <br /> z �J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. O <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER J <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. 'D o 0 o v c 0 b <br /> 7. <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 w n c n c <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this _ S b,N b <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I p ro : 22 o r" <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this 5 y <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 reasonabl a for the purpose of inspection. R <br /> c m ° <br /> OWNER'S SIGNATURE /U- I Y-20/� n (f'Dl�a? W d R x z <br /> (date) Tao sa H `� K7 <br /> ZONING ADMINISTRATOR <br /> ✓ c ss^ � w <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE y C U <br /> UU � oo � � <br />