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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g � <br /> APPLICATION FOR LAND USE PERMITS y. Z <br /> Q' N <br /> OWNER ,p �-�t_ TELEPHONE ( 1 !n /q I j C 1 n V <br /> of 1 C. O J V) m <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS +� 0"� / 0 � <br /> LEGAL DESCRIPTION 0 ( ,O 3O o <br /> Vol y� I�k� 4� o r� �awn � <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ AD ITIgUld DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ TT <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o <br /> STRUCTURE/ADDITION USE: �L" o <br /> (Home/Cabin; Commercial B``usines ` edroom; Deck; etc.) <br /> BUILDING CONTRACTOR: CKI <br /> 1,t.1 n TrN �✓h �\ <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN B rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. +� <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. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW l� w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, C7 v 3 S <br /> AND INDICATE NORTH (N). J Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) O <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 15 UJ <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. I O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES SR., QJ i <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m r <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 /> I C} <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN —' r .� I <br /> NEEDED. V i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Ul r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ZZ ZZ n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I to x <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLCWED WITHIN THE REQUTRE, NATER <br /> SETBACK AREA. G 1 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I <br /> NOT TO BE USED FOR HUMAN HABITATION. U <br /> 6. <br /> 7. > o 0 0 o>.O b <br /> 1 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 detall and accuracy of all 'L m <br /> information contained In this application(including any accompanying schedule)and I further declare that 1 recognize that this > > m N Y <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 thisc ;n N ''2 N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have a G: o o o o <br /> access to the above-described premises at any reasonab a me the purpose of inspection. ° w ii o w o o y <br /> E, > o00 00 "I <br /> OWNER'S SIGNATUREAff- -n o m a d m z <br /> ZONING ADMINISTRATOR2,012 <br /> ° cam <br /> TOWNSHIP PERMITS MAY BE REQUIRED RNETTCOU <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAReeZONING <br /> 0 0 0 0 0 <br />