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C O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS 3a7 4S(o y <br /> OWNER " TELEPHONE a n <br /> ��/z 6 7o SS�7 <br /> MAILING ADDRESS c aDa07 F(££Qea{ CED�RY� <br /> PROPERTY ADDRESS <br /> < IC <br /> LEGAL DESCRIPTION S <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GA'F/ACCESSORY STRUCTURE (�I <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ \� <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: -5"7-0/2 /1G f o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) O <br /> BUILDING CONTRACTOR: F— a /2I d'JCNZN n (n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ J <br /> WILL BE RETURNED. <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 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW rM w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). n, c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) $ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK 5' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p OQ O <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES N <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. v, <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 i <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 H <br /> NEEDED. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER \ <br /> SETBACK AREA. Q(lj <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. 1 <br /> 6. 3eP4--,c-TaoK rnustb-e ? to <br /> 7. fyorv, Stru.c-I-u�,. z > g o ; a <br /> yzo0" O5os. . z <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 ,Z � � � ? w <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all P. <br /> ' m d. d, 'S <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 m c a w= : 'y7 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to <br /> have access to the above-described premise at any reasonable time for the purpose of inspection. m � 'A <br /> to w n <br /> 's7 g0009� <br /> OWNER'S SIGNA RE <br /> (date) a m O <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN E <br /> A'f /S�} Se.114a-K <br /> l v V �e NSB �I ��a� o-r SBFT 1�9�C� 1 ar pha^e ( Jr !°� _/l) <br />