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N z <br /> c � o <br /> 6 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrators: � �1 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER <br /> TO nNNI SG / ! TELEPHONE/D / s//_7O d <br /> MAILING ADDRESS - �1 Ln `bc) <br /> `tJC•l <br /> PROPERTY ADDRESS <br /> _5V *20 cy <br /> � � r <br /> LEGAL DESCRIPTION °^ <br /> TYPE OF PERMrT(s): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTUR <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S '� <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: /// ✓ S�/f" r <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. T• <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCA <br /> 2. SHOW THE LOCATION AN E OF ALL EXISTING BUILDINGS/STRUCTURE (EB ND ALL NEW p 011 <br /> 3 <br /> BUILDINGS/STRUCTURE (NB NCLUDING DECKS, PORCHES AND OTHER CTURES, �I v <br /> AND INDICATE NORTHs(�, o z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) v5 1 <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARKT d G <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. �U <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. 9" c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE Cy <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Oo I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN '� 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ( r- <br /> 1. <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK ARE_'.. <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. ,yan a � o <br /> n on <br /> Nz � � o . �. z <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 K= _ = 6 ao <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all y d d d ! ! .j <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this E. > > w N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m ?c a '" .0 <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 <br /> have access to the above-descri d pr, Wises ny sonable t' a for the purpose of inspection. D `?w N u <br /> n <br /> OWNER'S SIGNATURE rronvinip <br /> (da 6ri c� tpm O � LnZ <br /> ZONING ADMINISTRAT o o, <br /> . vas v m [im'1 <br /> rn C x a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSIBURNETT COUNTY <br /> ZONING do o <br /> � � 000a � <br />