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b z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS r W <br /> OWNER ` TELEPHONE amikm / L'/— ^1 L7�'?Y� a w <br /> MAILING ADDRESS (P•�7! 0��� <br /> 4a G 1'Q <br /> , ` <br /> PROPERTY ADDRESS ar „) 5—T i <br /> 'L pyun� n � O <br /> LEGAL D SGr ON <br /> �,tn� NyPRswl'14 seTj„gn 3y T ►�\f� Res Ml V $ o I}L S <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION 11 DECK GARAGE/ACCESS Y STRUCTURE ❑ w+ <br /> �C. <br /> BUNKHOUSE El 59.692(1V)GAZESO ❑ STAIRS El FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCCIIAAL`ADDITION ❑ COMMERCIAL ACCESSO Y STRUCTURE ❑ / A <br /> STRUCTURE/ADDITION USE: ArccsTot- '�/ ©('t' z <br /> (Home/Cabin; Commercial Business; B oom; Deck; etc.) <br /> BUILDING CONTRACTOR: O <br /> m � <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> Iii � J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 tel w <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH (N). z <br /> 3. SHOW DIMENSIONS 1N FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S) ° Z <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. 1 <br /> G " 1 <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. 5' <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 4__. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE o 1 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 4— W <br /> NOTE: NUEDNG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y C) <br /> Iw1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ,� V <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, m O <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER ^ , \ q <br /> SETBACK AREA. `,jJ \J 11 C7 <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. 8 CCEEM <br /> 22 2 <br /> I declare NN this application(including any aacompanykV Wwdule)has been examined by me and to the beat of my <br /> R <br /> knowledge and blot it Is true,correct and mmpNfe. I acknowledge that I am responsible for the dealt and accuracy of all y=m a <br /> Information contained In this application(knckrdkng any acoompanHrq edwdule)end I fwtlm declare that I nK*Wtca Nat this <br /> Information I aprovldBlq wl4 be relied upon by the CnuMy of Bonnet Wisconsin In determining whWW to lone a pent. I <br /> hmtlwr accept ail gabgltyNat may be a.m of the Couray of Burnett relyknp on I I am provkli ng In this ,me„ g <br /> application. I agree to permit warRy of kleb chwged wlth a&.ibm'sbatlrng cotmtY ° n g 8 0 .rr <br /> access to the above-devalbed pry at any reasonable time far the WTcae of 6 °R o.V3'-H > <br /> 8 c o 8 y <br /> w <br /> yp � U <br /> D L ► <br /> OWNER'S SIGNATOR � .� ' <br /> f;aY ZO`09' � s� <br /> ZONING ADMINISTRATOR y [; <br /> BURNETT COUNTY a ^ <br /> WNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF39."E �« <br /> Uuo ��So8 <br /> 5-ra-oR Sir vr'e ( s <br />