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ON COMPUTER/ CAIIN D 3 0 <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> O <br /> APPLICATION FOR LAND USE PERMITS y <br /> � G <br /> OWNER TELEPHONE�� (� o <br /> MAILING ADDRESS <br /> 14151 <br /> 14'5I 1 n W i J rn yV 'a �p <br /> O <br /> �: 7-� n •) <br /> PROPERTY ADDRESSa� r\ o <br /> (� r <br /> 0 <br /> LEGAL DESCRIPTION j <br /> TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK❑ GARAGE/ACCESSORY STRUCTURE❑ 4, <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING CyOMMEI DDITION COMMERC1t4�L ACCESSORY STRUCTURE <br /> ITION <br /> a Y/`l' cK Glc"RJv�. <br /> STRUCTURE/ADDUSE: <br /> ome a in;LOrnmercial Business; room, <br /> BUILDING CONTRACTOR: Q IF M <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ih X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G y <br /> WILL BE RETURNED. <br /> n c <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) y <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ,, <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATERX- <br /> SETBACK AREA. 0 U <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GA GE/ , RAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. cJ <br /> 6. eleVCLto�l ;from a lrcet ct�sulrveypl�m.ustSbe e��r+rd to �An�nyal-�d G <br /> 7. T el I'e4 iuye✓y ot5 prcor 4-9 cvnSrrcLcht),) . 9nnfim > O 'S7 <br /> I 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 detail and accuracy of a.. <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that thisE. D y <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I e ? 5 c no= "7 <br /> further accept all liability that maybe 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 C c. g rrr <br /> have access to the above-describ mi� at an r�soanable for the purpose of inspection. °W n ? g <br /> OWNER'S SIGNATURE L" A o, c g 8 g y <br /> r. <br /> (date) <br /> 20NING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR EROM DATE OF ISSUANCE <br /> Ie+4R( "UWt fD b-e(+ &()&j '�R-la-// <br /> M <br />