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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 /> m w <br /> Q N <br /> n J <br /> OWNER // TELEPHONE <br /> MAILING ADDRESS Fob T � N ,-55-T71 <br /> 1 <br /> PROPERTY ADDRESS <br /> /'nD J'-�,�1�y� = —< <br /> ( 1(yE2 c' E <br /> c� a <br /> LEGAL DESCRIPTION 1 S <br /> �+ ?_ mow( ti 5 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> a~ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ � (] <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCCCESSORY STRU URE/0 S � <br /> STRUCTURE/ADDITION USE: _ S / 1V 1 v� i I 9 - <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) I�_t o <br /> a <br /> BUILDING CONTRACTOR: lk J Q .& <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vt X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M C <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(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 'r <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 3 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ti <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 <br /> y <br /> NEEDED. I <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 B <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. ti <br /> NOT TO BE USED FOR HUMAN HABITATION. ' I ,(� / <br /> 6. Open, Sereer i a-, o 10&"k- ©/� �y too,(qtr` '?s`f S`�'tl�LC lo tI" <br /> w.ss. sq, tw@ Iv) V �.} (� p <br /> 7• SILO re�1 .ner'UG T/oh 1�MGi rlim r-Gcarrj ON I/��C I�A'fY�l n 3 3 k ?? <br /> I declare that this application(Including any attanpanying schedule)has been examined by me and to the best of my 3 0 <br /> knowledge and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all g tp m m,o <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this " E.D D to N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in detem fining whether to Issue a pemtit. I 5 ?w v <br /> further accept all 1lability Mat y be a'it of the County of Bumett relying on this Information I am providing In MIs 9- <br /> application. I agree to permit my ofitlals charged with administrating county ordinances or other authorized person to have <br /> access to the above�escrihed ices at any reasonable a for the purpose of Inspection. a7 a o g g <br /> OWNER'S SIGNATURE A Aln&a <br /> � (date) <br /> ZONING ADMINISTRA y E 'c w' S t I <br /> TOWNSHIP PERMftS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FR M DATE F ISS �+1�CE C»= «H <br />