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0 <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS -� <br /> R <br /> OWNER TELEPHONE e <br /> rye 1 <br /> MAILING ADDRESS G—j,� CO��1 c„C�� J C/- Ar n /I id 56 <br /> PROPERTY ADDRESS`.J?V 0')/v3 dta vk K—d 0561-7 r \ <br /> J VJ <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION EI DECK ❑ GARAIGICESSOR vi <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS EI FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDINGn❑�MCOMMERCIAL ADDICTION ❑ COMMERCIA�Lf ACCESSORY STRUCTURE a � <br /> STRUCTURE/ADDITION USE: 0D(mour-hal 'SfDra e <br /> f., o <br /> (Home/Cabin; Commercial Business; B room; Deck; etc.) VJ (� <br /> BUILDING CONTRACTOR: <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o I� <br /> WILL BE RETURNED. 0 _ H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ...� O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. rM <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m -c 9 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3 <br /> 5 <br /> AND INDICATE NORTH (N). '� z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) S? O <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES W <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. y SU <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 ^ o SJ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. /a� „C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ..i �/1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (n W <br /> �^ Al <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. H <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'O v <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. Q� <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. F o <br /> a <br /> 7. ^ >JJ an nn C) aero <br /> r1 Di y 3 3 3 N a n <br /> N 3 3 3 <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 g r F r <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this 9 E. a a m Y <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I .� L" <br /> c, __' <br /> further accept all liability that may be a result of the County of Sumett relying on this information I am providing in this c � N ,, '_^,�, b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ' u <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. o o o <br /> m waowNooa <br /> OWNER'S SIGNATURE -' 2 A 6 0 0 0 0 0 <br /> � �. Tc o ze�f/ Lw <br /> se a <br /> (date) <br /> ZONING ADMINISTRATOR e Q @ w " o^ <br /> x i <br /> TOWNSHIP PERMITS MAY BE REQUIRED A <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM D TE OF IS N 11 N <br /> le-Pf e (' w, eo( pec rafea� -`COs a� rl � � 00000 <br />