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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 a y <br /> OWNERSC4t /e!' TELEPHONE -715-- 92"t- `/6yS' = o <br /> MAILING ADDRESSjp27 C ��� � ` � `• V <br /> UU L /�,L r• y1C �• . C�� S y,ll I� '° <br /> PROPERTY ADDRESS <br /> 30472 7d,&e La r �%nLmry 54/836 C) o <br /> LEGAL DESCRIPTION <br /> dot 3 (25Y!'1 (/Ib P213 Nk) -5 F_ � <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION D DECK O GARAGE/ACCESSORY STRUCTURE IS <br /> BUNKHOUSE O 59.692(1V)GAZEBO O STAIRS O FILLING/GRADING ❑ CAMPING UNIT O it <br /> COMMERCIAL BUILDING D COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURED c `% <br /> STRUCTURE/ADDITION USE: S Z (� 1 <br /> (Home/Cabin; Co mercial Business; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: S n <br /> n T <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'k X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o Q <br /> WILL BE RETURNED. ; v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) mL� a SCi.I <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, o ' <br /> AND INDICATE NORTH (N). R� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) P \ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w5" Q Cn <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 QJ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5. m , 'A <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 D o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN CN <br /> NEEDED. r P <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r. <br /> A C O <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. A O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER C <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. F <br /> 7. `A � oo o CId07 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 c R S .°= w' <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all ii m d a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .'� c_ D 9 <br /> Information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 a = <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 /> acceiss to thela6ove-desvibed premise <br /> ree to permit dals charged <br /> easonablewith <br /> tlme foir administrating <br /> of Icounty Slpectia�,or other authorized person to have o o o <br /> „ w � aWwN n <br /> n n o 0 o y <br /> OWNER'S SIGNATURE A A 6 6 0 0 0 0 0 <br /> yo'1101 <br /> oWdoyz <br /> ZONING ADMINISTRATOR [�17 <br /> APR 2 0 2012 N a. <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUffiffiNm COU <br /> � �00000 <br /> ZONING <br />