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Z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator < ' <br /> APPLICATION FOR LAND USE PERMITS <br /> �• a <br /> OWNER T� I N 99 TELEPHONE ���/'1 - 71 0 - Q,5 q• o <br /> MAILING ADDRESS 'S (,� ')I r�X t° I WG�/ Ale 1/Cct,le I j" A) I o <br /> PROPERTY ADDRESS / GS� GOn Lk . an Luecwn <br /> LEGAL DESCRIPTION Lot a) CSM PA M0 y. 7 . PT.g- R/ �/ o;, LO{- o j <br /> y <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION ❑ D K❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING [D CAMPING UNIT❑ <br /> -o <br /> r ^' <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: rQ.G IP 1Sfo ra-G s: ©h fit/ ° <br /> (Home/Cabin; s; Bedroom; D ;etc.) <br /> BUILDING CONTRACTOR: 04,1A, P l n <br /> O � <br /> z o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 00 - H <br /> WILL BE RETURNED. n <br /> n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m w <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, J 'v <br /> AND INDICATE NORTH(N). o o OG Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) p911 9. ° <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK I 00 C> <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 4- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE 1 <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p 'p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. y <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. p. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 8 <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> 7. z z n o 0 o n > O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0,°z = = = o ? aEi <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m w m EL <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this `0 E. > > tc N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 <br /> have access to the above-described premise at any a e time for the purpose of inspection. �', > w N ss n <br /> _ F w U o a <br /> re <br /> OWNER'S SIGNATURE m `; " o � O 8 <br /> A 6 <br /> 0 <br /> (date) 6H 6 y w o <br /> ZONING ADMINISTRATOR o 10 �' 'c`o "17 <br /> TOWNSHIP PERMITS MAY BE REQUIRED =? <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IssiM I INETT COUNTY S <br /> ZONING N oo <br /> 00000 <br />