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fn 9 Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS H <br /> ° cC <br /> TELEPH <br /> ry <br /> OWNERII �u we(� 7G3 -d-&S-Sa3q O�ryE / 6/a E33 '/(/ay a <br /> ll d <br /> MAILING ADDRESS t� <br /> �S/R3 Up,a �� S� NWovv Mn1 SS3oI/ <br /> PROPERTY ADDRESSII � o /^ <br /> Jttn 04nnln <br /> LEGAL DE CRIPTIO,N r -- <br /> LaF 5i.t %{ S W Y, Sec 33 -rqr N R j` W TWp Sw;gf <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 04 ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ v, <br /> �. _ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r- <br /> � 3 <br /> STRUCTURE/ADDITION USE: a <br /> (Home/ abi , Commercial Business; Bedroom; Deck; etc.) . G <br /> BUILDING CONTRACTOR: _(1 / <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va 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) a <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 R <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, (� <br /> AND INDICATE NORTH (N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) S r� <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK FS N O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p ! (JJ <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES — Q} <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. J 9-� CPi <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r <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 UU <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. <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> Z, ^ gy > nnnc,> oro <br /> 3 <br /> N 33 � -: - 77 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my E o,°Z <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this E-> > m „, <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I - m ?w >Y <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 have <br /> access to the above-described p mises at any reasonable time for the purpose of inspection. ° w R <br /> n > 000 � o '1 <br /> OWNER'S SIGNATURE aL <br /> nd, a� mno � m0 <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPLRE NE YE FROM,DATE OF ISSUANCE <br />