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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P <br /> APPLICATION FOR LAND USE PERMITS a Z V <br /> r <br /> OWNER TELEPHONE <br /> J lP3a o <br /> f-t J �/� 3 = _7 w <br /> MAILING ADDRESSn _J ,' / 113 11 J 7 <br /> F Ss,lF�2 /h�/ � \ <br /> PROPERTY ADDRESS <br /> O <br /> LEGAL DESCRIPTION � <br /> o_ <br /> TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING❑ ADDITION DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ rn <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ <br /> COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r <br /> STRUCTURE/ADDITION USE: it G n/(e �.; �'. ' f' yr 3 C <br /> i 7J /fit G.sS �' .r P <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cr Krlt�t � I p <br /> BUILDING CONTRACTOR: �LY <br /> n <br /> � N <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> +: y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> n <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 'o c <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ,a <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) 0 0 <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. °O <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ti i <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. W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 4-- <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '9 C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. I 1 <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARA <br /> a. GE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATIO <br /> Nu extva 6�Gf1!o�mS bv, -I�tS �e✓m�� � <br /> 7. <br /> � 7y >; ;;np > oro <br /> I declare that his application(Including any accompanying schedule)has been 3 <br /> examined by me and to thc c ^ ° ° <br /> knowledge and belief I[ttru e best of my <br /> 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 m �_ <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d a Y <br /> further accept all liability that may be a result of he County of Burnett retying on this Information I am providing in his ' c 2 c <br /> qo <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have h ° ^y+ 'v $ c t" <br /> access to he above-described premises at any reasonable time for e purpose of inspection. o C' <br /> m w � i3�W�� n <br /> o 0 o g <br /> OWNER'S SIGNATURE q � a ya <br /> (dabe) d ornDomd96 ,Oz <br /> ZONING ADMINISTRATOR <br /> •� 0� : � w �+ o� C�7 <br /> L/ 9 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O ° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR OMD TE OF ISSUANCE <br />