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C a <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g a <br /> APPLICATION FO LAND USE PERMITS <br /> OWNER <br /> 1� t Che 2�K as <br /> MAILING ADDRESS .. <br /> �3 d' ° <br /> 1� 'e <br /> PROPERTY ADDRESS Q Ai/ e /j1�e / �� U� g Q O \ r <br /> W/I O ° <br /> LEGAL DESCRIPTIONae S/k <br /> TYPE OF PERNIT(S): SIN LE-FAMILY DWELLING ❑ ADDITION ❑ DECK El GARAGE/ACC RY STRU 2 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO ❑ STAIRS L7 FILLING/GRADING ❑ CAMPING UNIT 0 wic- <br /> COMMERCIAL BUILDING L7 COMMERCIAL ADDITION ❑// COMMERCIAL ACCESSORY STRUCTURE ❑ G <br /> STRUCTURE/ADDITION USE: l L J,1n <br /> ed CD o <br /> (Home/Cabin; Commercial Bu i s; Bedroom; Deck; etc.) <br /> C <br /> BUILDING CONTRACTOR: ONIE 1 _ <br /> n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. e <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). N c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ° r <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w c6 a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. ty < O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES 3. e N <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. A N <br /> S. 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 N O <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. c (u <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN yCO <br /> NEEDED. . <br /> THIS PERMIT IS SUBTECT TO ALL CONDITIONS LISTED BELOW: r p <br /> Sc- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n ° <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N z o 'D <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 5°p <br /> NOT TO BE USED FOR HUMAN HABITATION. F r{ <br /> 6. O <br /> 7. R 3 B 3 P a M <br /> Z oR R ° w <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my B 0 .2 R <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all to F E E <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this c-> a m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I a w <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 haveA Z o$ ,r"„ <br /> access to the above-described premises at any reasonable tirrAfor the purpose of inspection. m n a o <br /> OWNERS SIGNATU �."— - � c7 V1 E: O <br /> ,./ (da ) o g � Z <br /> ZONING ADMINISTRATOR G 2.� X2'/7 l� y 9 . <br /> TOW SHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br />