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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y <br /> s <br /> OWNER IA TELEPHONE W5 <br /> 7 7k� m ru� <br /> MAILING ADDRESS `7� '� / / F) <br /> VH J7S Y1 ` <br /> PROPERTY ADDRESS �3d <br /> o <br /> LEGAL DESCRIPTION ICI 6 <br /> TYPE OF PERMrrm: SINGLE-FAMILY DWELLING ADDITION 0 DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ S9.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ a <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ n <br /> STRUCTURE/ADDITION USE: _ Z�f X Zy liP�blh Iyt-64 ©e�K (o'� B X /G Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> 0 <br /> BUILDING CONTRACTOR: <br /> n <br /> 'r7 <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rk X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m �' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW .+i '°��° o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, ,C7' o' <br /> AND INDICATE NORTH (N). Z <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 C9 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. cy <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. y <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 6 0 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN S21 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Qb1 r- T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. V n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 6 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER I\ <br /> SETBACK AREA. (V� <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. f <br /> 7. s > 0 0 o n > C; <br /> i; 3 3 3 <br /> H S <br /> 0 <br /> 3 3 3 0 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 c =° °, ,_° <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 v n 9 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I .� a. > a S= <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c y w d,` e'N 7 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> P Y P rpose of Inspection. <br /> access to the above-described remises at an reasonable time for the u w ti w a <br /> 6 O O O <br /> /ALTJ N D OO OOO „'i <br /> OWNER'S SIGNATURE Y/l — 7 — // <br /> 3 a $ <br /> (date) $> > 3 _ <br /> Ts <br /> 5 <br /> ZONING ADMINISTRATOR ' Z _,H w'- " o^ �v7 <br /> TO SHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N o N N o <br /> 00000 <br />