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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 a ry o <br /> a oy <br /> OWNERGL TELEPHONE o <br /> C � -( <br /> MAILING ADDRESS S55 `� ct.✓1C�U K. <br /> {� 15 Po Pfairi 30 <br /> PROPERTY ADDRESS <br /> �f-� °- <br /> LEGAL DESCRIPTION S <br /> TYPE Of PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE E. <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ � <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: <br /> ome in;LOMmercial ousuness; a room; c ; etc.) <br /> BUILDING CONTRACTOR: m M <br /> O � <br /> 77 < <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> � 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 O o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J C4 3 <br /> AND INDICATE NORTH(N). 6 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) SU <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 0° p <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. p I <br /> S. 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. UJ W <br /> w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> Fri <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: d n <br /> O lS <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. yl Z i p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. b F <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 <br /> SETBACK AREA. O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. C f <br /> 6. <br /> 7. > av <br /> � oonro <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 o, y <br /> Information contained in this application(including ny accompanying schedule)and I further declare that I recognize that this A E. D W N <br /> information I am providing will be relied upop by County of Burnett Wisconsin in determining whether to issue a permit. I c S [ y <br /> further accept all liability that may be are;dit oft County rnett lying on this information I am providing in this = rro d,, N ro <br /> application. I agree to permit county officials ch ed administrating coon nanc or other authorized person to ^ O = ' ^' ' 8 <br /> have access to the above-described premises at ny re nable time fo of i ectior o D <br /> N �wNgga <br /> OWNER'S SIGNATURE ! ems c S g o <br /> (date) n yi 9'2 m n M C <br /> n� <br /> ZONING ADMINISTRATOR 1m EI W ' an <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> C ' Fd <br /> C H1 ' IF <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU�ATNCE $ <br /> r'eiM4 '4 12-�'W P(GeQ ly bij FlOdin l lJh fid` ��a000 <br />