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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> �J / a r, <br /> OWNER , el ul� ,L . /����G SO ,{ / TELEPHONE ������/ 33` <br /> MAILING ADDRESS ///33 J Q „//-/� L� t?/A/T �� AYj?G�, I .(1✓. S53 Z? V <br /> PROPERTY ADDRESS � c`7yt w e ���� <br /> ( / < n c <br /> LEGAL DESCRIPTION I r <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE K <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ 5 0 <br /> STRUCTURE/ADDITION USE: 7r1r { <br /> (Home/Cabin, ommercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> r <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. 0 <br /> Y' n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m O <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 In w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 <br /> AND INDICATE NORTH (N). N 'Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) 5 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <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. <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 <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 /> �J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z n CX7 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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 ni <br /> SETBACK AREA. Icy <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> y. A o 0 0 0 oD. p 'O <br /> El 3 El <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my 3 <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 <br /> in <br /> her <br /> lare that I <br /> information 1 am providingiwillpplication be relied upon by thncluding e County of Buring nett Wisconsin In determining rcwhether to issuena permit. I w `6 c 6 W <br /> ' S �°<, '9 <br /> further accept all liability that may be a result of the County of Burnett relying on this information t am providing in this � <br /> application. I agree to permit county officials charged with administratin county ordinances or r authorized person o E <br /> have access to the above-des premises a[any r sonable time fo a purpose f i pe / 'Q / D ;y ti szon O <br /> OWNER'S SIGNATURE yam/ 00 0 0 0 0 <br /> / A R 6 <br /> (date) n 69 > m w U4 71 � <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE /OF ISSUANCE <br /> �'�✓/ti'be I- r �e �� �r '�G L� l%l �' �'L;�f/ f �i�G-:G 1� �'' �7/ -��'� ��rJ o 0 0 0 0 <br /> l <br />