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y Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y <br /> a <br /> OWNER . PA-C /C'E ' TELEPHONE <br /> O <br /> MAILING ADDRESS n/y/ l' ` `/1� !t�'� �� ACJ `. 7 G'�J�T'?"fJ 7. ry ��/P1,Q•j V <br /> PROPERTY ADDRESS7 <br /> 1`jl.5 C', ; o <br /> 5 <br /> LEGAL DESCRIPTION S' <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 0 COMMtERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S o <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; <br /> /etc.) ,,f � <br /> BUILDING CONTRACTOR: LL)I� ��/(l "y([ !(/ /`L rl � n W <br /> JAf <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHE OF PAPER. ANY INCOMPLETE ORI LEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. y ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW tf w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). No <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) ? J <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w, G <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 cl1 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ' <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. �ry <br /> I v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN )J O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I <br /> C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ti z G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C p, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER / .I <br /> SETBACK AREA. W <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. py 9nr] f1 G)D � <br /> El 3a <br /> S C' <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my3 p 2 <br /> 5 <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 contalned In this application (Including any accompanying schedule)and I further declare that I recognize that this o E. Y W N <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I ? g a = [ <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 <br /> access to the above-described premises at any reasonable time for e p f Inspection. <br /> R A F 6 0 0 0 <br /> OWNER'S SIGNATURE 12 -2 -01 a n, <br /> � " aoW � Ei <br /> \� �y-� /y ^ (date) o o, o v a <br /> ZONING ADMINISTRATOR v I' I ! FIao(�1 G�� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> t n S O O O O <br /> Perrnt4 6p b,� ��ncerSm ��h �Z3�9 <br />