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z <br /> a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3' <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER TELEPHONE1&__L� _ d <br /> _JI T / O <br /> MAILING ADDRESS <br /> IAJC <br /> PROPERTY ADDRESS o <br /> l S ^ <br /> LEGAL DESCRIPTION /_v �,�, E V �W 1/9 S _�T _ R - /7 W 1714W IP( <br /> caw <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S <br /> STRUCTURE/ADDITION USE: <br /> P <br /> (Horne/Cabin; Commerdat Business; room; ec • e c. 1 <br /> BUILDING CONTRACTOR: n <br /> O � <br /> 77 < <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O h <br /> WILL BE RETURNED. no <br /> A a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �° <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW d o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 <br /> AND INDICATE NORTH (N). c 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 O <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 o. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ,, <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. S� 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN C___)�) I <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. T n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ppp� N <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. ry <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY, rV� <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. �O > 0 00 ync '0 <br /> ry A f N y <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of myB o no � n <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this `9 E. 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 ? iia= Y <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this N 0ro0 <br /> application. I agree to permit ceunty c1111 charged w administrating county ordinances or other authorized person to O <br /> have access to the above-describe p mises1 an re able time for the purpose of insp6 „ D <br /> 0 <br /> lv � 2 �''� ooY <br /> OWNER'S SIGNATURE 9 A 8 o 0 0 o y <br /> � A c � <br /> ( n � n? cv 8E =� 2 <br /> 0 <br /> ZONING ADMINISTRATOR �g §� a Ak <br /> °c ao o C) <br /> " : c <br /> OWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAJ"NINGS <br /> =N��No <br />