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y o Z <br /> m <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS I= a Q <br /> OWNER / S l� 3G,' TELEPHONE '7 7 -52o —U 3.7e <br /> MAILING ADDRESS / 6;p <br /> /+ <br /> 3 <br /> // 377o �; y <br /> PROPERTY ADDRESS 7�36'f0 _S-;" <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): INGLE-FAMILY DWELU ADDITION r DECK r GARAGE/ACCESSORY STRUCTURE r (n <br /> r Ib <br /> BUNKHOUSE a 59.692(IV)GAZEBO r STAIRS r FILLING/GRADING r CAMPING UNIT r <br /> COMMERCIAL BUILDING r� COMMERCIAL ADDITION r COMMERCIAL ACCESSORY STRUCTURE r <br /> STRUCTURE/ADDITION USE: /7''O An C <br /> ome/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> T � � � <br /> BUILDnnING CONTRACTOR: Lt r i s rJ'I 7z,� O ti <br /> CJT � <br /> R o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2X11 SHEET OF PAPER. A14Y INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 <br /> � ro <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 O B <br /> BUILDINGS/STRUCTURES (NB)rINCLUDING DECKS, PORCHES AND OTHER STRUCTURES, gY <br /> AND INDICATE NORTH (NK �. r <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) \ ao _ O <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK p <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. ^ !V <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. -f- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THEOQ <br /> Q <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN -3 <br /> NEEDED. UI 'A' <br /> tj <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: C. <br /> o z a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS Of PERMIT. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER G Y <br /> SETBACK AREA. O <br /> ONLY. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE o <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. g g °ga <br /> 7. A399at�nJ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <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 c E Y m2 . <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I w 5 u ?w v <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this g, : w : H N 'd <br /> application. I agree to permit county ad with administrating county ordinances or other authorized person to F <br /> e- <br /> have access to the abovdesc' ny reasonable time for the purpose of inspection. 8 o <br /> y 's7 r� 00000y <br /> ( <br /> OWNER'S SIGNATURE <br /> (date) <br /> ZONING ADMINISTRATOR ((n ecc in ll( n . ' : 5'. o' <br /> TOWNSHIP PERMITS MAY BE REQUIRED p ' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> pe(r►,C++ l e+4e✓ p rce k p bt, W6L✓+o4-+ 660t-) 7-r u-11 <br />