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y ? z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS n <br /> 65I- Zo <br /> OWNER TELEPHONE 651- 20-1-1-ForF <br /> or = \ <br /> �' 16Si- 4S7- 391Z_ r <br /> MAILING ADDRESS ;201f-1{{� - fi `'D U�( 5'� 110. ' AM. SS3� s <br /> PROPERTY ADDRESS Z3(pS9 -V W_15�97/ <br /> LEGAL DESCRIPTIONZD} I3 (J) <br /> D f b�t�i�c�o✓� <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLINGA ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ w <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS Cl FILLING/GRADING D CAMPING UNIT❑ <br /> (C j <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ � ^ r. <br /> STRUCTURE/ADDITION USE: e, <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> � f !! <br /> BUILDING CONTRACTOR: M �l4✓-tom' K S ^�'i Uj,� _ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 6 /a X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS I$ o '.'r <br /> WILL BE RETURNED. r <br /> ,yy M wclJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c �; J <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW t�� v: <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). VJ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(5)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ,s O 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 52 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ✓: t <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> by O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. raj Z Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B _ o, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <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. Si <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. "gg •b D a o�' cj q <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my F m' <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 ° > ' <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .^''. c _ S <br /> further accept all liability that may be a result of the County of Burnett relying on his Information I am providing in this <br /> application. I agree to permit county officials charged with a n ting mun rdinances or other authorized person to have <br /> access to the above-descri4o"rerrbes-dt any reasonable[I a fo a purpos o Inspection. <br /> OWNER'S SIGNATU "'-------- '> <br /> (date) a.�. imZ <br /> ZONING ADMINISTRATOR CUn( an <br /> =nisi <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE »= L' L,!A`a' <br /> R�/�'1 -_'f I � 112r/l�( le� {o�� n �QCh � 8-f� 0� rsso� � <br />