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C N Z <br /> O <br /> a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administratorir <br /> APPLICATION FOR LAND USE PERMITS a <br /> - 0 <br /> OWNER ! A0 ✓✓I,AS �} A/Z,J,�K TELEPHONE <br /> y- /S.��s-3 y2zI <br /> r0 m <br /> O <br /> MAILING ADDRESS <br /> PROPERTY ADDRESSve 1)'le J'j Iq <br /> LEGAL DESCRIPTION cal 19 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTUREX �. <br /> BUNKHOUSE FS 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERC L ACCESSORY STRUCTURE❑ S '� <br /> STRUCTURE/ADDITION USE: , o <br /> (Home/Cabin;CommercialBusiness; Bedroom; Dick;etc.) <br /> --� <br /> BUILDING CONTRACTOR: S,_Lr <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c, d <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. "d <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, o <br /> AND INDICATE NORTH(N). O\ N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS) <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o V <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <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. 1\> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <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. \ i 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. -�I_ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Wer, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. J n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. VL <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 543 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 00 <br /> SETBACK AREA. o <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT _ <br /> BE USED FOR HUMAN HABITATION. <br /> 6. N04-_ hOu�n 1n I�IC:p <br /> 7. ON51TE SL4 112, OK - 21LT '� o 0 0 a o �a <br /> zo � AAoo . z <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my g <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all R <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this _. D m ,,, <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m n w v b <br /> further accept all liability that may be a result of the County of Burnettrelying on this information Ism providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to 8 0 .r. <br /> have access to the above-described muses at any sonable time for the purpose of inspection. 8 D <br /> m � �oNgoa <br /> OWNER'S SIGNATURE 9 A N oo O o o y <br /> rt a o <br /> ( ate ny> Q� mn v, _n, 0 <br /> ZONING ADMINISTRATOR WAY oa, a Yy <br /> I HIM, <br /> TOWNSHIP PERMITS MAY BE REQUIRED ry E <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISTT <br /> COUNTY <br /> m o , <br /> ZONING d <br /> vvNi O O O O O <br />