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!1 ; Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g y <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER MSK D• s/ASO I TELEPHONE 1/5--OV-3152 <br /> MAILING ADDRESS �yy �lV dY C+Q 5r Qearx k&- 5-1/OZV ,SUI y <br /> PROPERTY ADDRESS <br /> 3 .3'/2 h/6rx,4/ Q,ptY/1�� l,(faz-gflgR� (�iL '� <br /> LEGAL DESCRIPTION 5 <br /> c <br /> TYPE OF PERMIr(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTUR ✓: <br /> BUNKHOUSE ❑ 59.692(1V)GA2E80 ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> .7 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> y <br /> STRUCTURE/ADDITION USE: 4tbm (WA <br /> c <br /> .9 <br /> BUILDING <br /> Commercial siness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �c <br /> n <br /> T y <br /> AP <br /> Q i <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8'/a X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS p c <br /> WILL BE RETURNED. r <br /> 8 <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 w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 5 <br /> AND INDICATE NORTH (N). <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. <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. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. —i <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> i 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ^ <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. £ <br /> 6. <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all s ❑y =_ �� -i <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> Infonnadon I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I ' =: ti <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized Person to have 8 S r <br /> access to the above-described premises a any asonable time r purpose of Inspection. a m paw�+� r) <br /> 9 ! O > <br /> OWNER'S SIGNATURE 3�D = °' <br /> (date) 9E <br /> ZONING ADMINISTRATOR Im <br /> Vic: � +f <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^ w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF : JUN 2 52009 " ^" <br /> BURNETTCOUNTY <br /> ZONING <br />