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Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER TELEPHONE 0 <br /> MAILING ADDRESS�Z� ci V o <br /> J� <br /> J <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTIO2. <br /> C5 M o L 1 , 2ZI z �a e 6a roZ ► <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK '^ GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: , 'z <br /> 0 <br /> onle In; L0Mrmrua1 business; room; 11cl; etc.) <br /> BUILDING CONTRACTOR: N S a 7Yy(CTI'J^. n <br /> O � <br /> A o <br /> A PLOT PLAN MUST BE PROVIDED ON AN S'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING (ARIAL OR TOP VIEW) ^ p <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 c <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N , <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. D <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES IEL �. <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. `(.-V I <br /> S. 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 4t 713 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONEWHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. h Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ip <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. dy <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER L9 <br /> SETBACK AREA. �y <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7 z o 0 0 0 DC7 <br /> � n N333 � a � [l1 <br /> ,,�, 3 3 a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my ° <br /> 3 c� � � � , 0 <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 f° E <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o;c a a= : Y <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am -providing 'G^ a Q0 <br /> application. I agree to g county D 9 in this _ <br /> PD 9 permit county o(fici Is charged with adminis[ratin coon ordinances or other authorized person to ° O v <br /> have access to the above-described p m' s at any reasonable time r the u <br /> p rpose of in Rion. o y <br /> OWNER'S SIGNATURE <br /> (date) ."^. fD c ° <br /> nom' oD.? cmm ,F m _ O <br /> ZONING ADMINISTRATOR � $ a � � 9 � . � <br /> ° nM <br /> � am <br /> TOWNSHIP PERMITS MAY BE REQUIRED � <br /> THI//S11 PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o <br /> pr2are" f�/in,� /wt✓S � s/�/ -(of-c-16 = 95'A-f- 0e&,-n( <br /> 0 0 <br />