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N b z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a (17-- lh1 <br /> APPLICATION FOR LAND USE PERMITS �� W <br /> OWNER (y)' A [ ` J HM 1' ) TELEPHONE <br /> MAILING ADDRESS <br /> lr f `7 p J x .L� S' w r�S <br /> rJ J <br /> PROPERTY ADDRESSLHK-F 12.4 tv/6e,57-4�� (/JL Sy0�3 0 1 <br /> PIN ,D <br /> LEGAL DESCRIPTION (J� I/y CF i ij 2i(v OI 33iL- 01 5l) ° <br /> TYPE OF PERMIT(S); SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> 'v <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 0 <br /> STRUCTURE/ADDITION USE: �F�RLV7 /STU/Kri7A is o <br /> (Home/Cabin; Comrh6rcilal Busines , Bedroom, Deck; etc.) �1 <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 '/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O 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. <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, —� <br /> AND INDICATE NORTH (N). NZ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) i/ a <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK m5 �, <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. d G !� <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES V" <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. y 1 <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 W <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. W <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 8 <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. � o o o o n a 1 t <br /> a = <br /> yzo �9g9 o ; <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my g o ,� B L. <br /> knowledge and belief it is true,correct and Complete. I acknowledge that I am responsible for the detail and accuracy of all to <br /> information contained in this application(Including any accompanying schedule)and 1 further declare that I recognize that this v g. 9 a N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I .".' a V <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this c o 'v,N" `�N .0 <br /> application. I agree to permit county officials charged with administrating countiwdinances or other authorized person to have <br /> : <br /> access to the above-described premisesat. any reason e.f6r the r of inspection. oo <br /> m w n o w N c o > <br /> ylS� a m no � � <br /> OWNER'S SIGNATURE z) v, a a o O <br /> (date) LE H �. K7 <br /> ZONING ADMINISTRATOR �y <br /> TOWNSHI PERMITS MAY BE REQUIRED / <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �� 0000S <br />