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Z z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS L <br /> OWNER n^ ry ,�„ I,{�a //,tt n� TELE/P/HONE pr �f1 G <br /> MAILING ADDRESS 1�Q� 7Q It SLf7oV W�r �FYLVI tile/ (It N II a"f C`/r1/ v <br /> PROPERTY ADDRESS ON <br /> 55 oa(%e -F <br /> LEGAL DESCRIPTION a Co <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ' GARAGE/ACCESSORY STRUCTURE ❑ Gy <br /> o, <br /> BUNKHOUSE ❑ 59.692(SV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ 0 3 t <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commerc,i1la,lBu�.�srivn�ess; Bedroom; Deck; <br /> s ' V"V etc.) <br /> BUILDING CONTRACTOR: Jw�ic. 4"M U&t <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. r, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m <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 M m 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <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. p <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. z <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 SO AN ONSITE VERIFICATION MY BE DONE WHEN _ Y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> F Q0 O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - F j- <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER A� �r <br /> SETBACK AREA. ^�F' <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 3 <br /> NOT TO BE USED FOR HUMAN HABITATION. I� <br /> 6. <br /> 7. '> 0 0 0�cd <br /> ? <br /> I dedare that this application(Including any accompanying schedule)has been examined by me and to the best of my g o <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all ai m d d a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this 5-D D m N a <br /> Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this y 22 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have B n 7 0 o o ► <br /> access to the above-desaibed premises at any reasonable time for the purpose of Inspection. ° i w a d;o Z' <br /> . �I13r W � , 0000 � <br /> OWNER'S SIGNATURE j 9- to t� con 0 <br /> (date) <br /> �'� '^ <br /> ZONING ADMINISTRATOR Ll i ) �Ian(GIGIY) <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> mi 1 e+-6' ()jai ltd 4-D rhar«. if {U/+-rr,�4 n 14-AO-16 <br />