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r � z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS � <br /> OWNER TELEPHONE 00 <br /> oAJi4[.D �/}RDL1N 7/S-lpS6- 38trD o � <br /> o <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS DAA18L)9 <br /> 1 11 <br /> W s SGcyh�C� o `1 Q. <br /> LEGAL DESCRIPTION r S� <br /> o Q <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ElCOMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ Io A <br /> STRUCTURE/ADDITION USE: o?'4CG E <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> IS BUILDING CONTRACTOR: JE1+F J ? <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> a <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. C <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, R (� <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) o U o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w' 1 wl <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p C> <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES q W <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 0 <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: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. �1 <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. R >r) nr napro <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 o. m d d rn .3 <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this f° E. a a w <br /> Information 1 am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I L' c w= <br /> further accept all liabllity that may be a result of the County of Burnett relying on this Information I am providing in this °_^N 7 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ° �,°� o ° o S1 <br /> access to the above-described p Ises at any[re onable time for the purpose of inspection. , / a 8 8 N w <br /> OWNER'S SIGNATURE �VI.Af aG /- ^y//,s>/O fD > d o o g g <br /> rna6mn <br /> ZONING ADMINISTRATOR <br /> _ a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN E " <br /> t�z✓✓n"L �- � l�l--fie/ b� �ov�a��l f�a�dfti� <br />