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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 0 <br /> APPLICATION FOR LAND USE PERMITS V;' <br /> = �?' <br /> 5 <br /> OWNER ,_j 4 � LD 3 � TELEPHONE N6&_ 8J ° <br /> n(D, b <br /> MAILING ADDRESS •'1Q /L-� `c/ °"fan l � /"o-T ,'T � rC, �I <br /> PROPERTY ADDRESS � \ W <br /> o <br /> LEGAL DESCRIPTION c rte' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE ❑ S L_ <br /> STRUCTURE/ADDITION USE: 3-�.. 9eubY1 fDorc/A (� c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) N' <br /> BUILDING CONTRACTOR: <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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), c c <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. ty <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. <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 /> Cr <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � 7 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. " C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <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. <br /> 7. > 00 0 4 ) cO �0 <br /> n y 3 3 3 a <br /> 1 declare that this application (including an accompanying x `3° '3° `3D ° ° S <br /> pp (' g y partying schedule)has been examined by me and to the best of my o � � � R <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 contained in this application(Including any accompanying schedule)and I further declare that I recognize that this C7 ti <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. [ 5 E °D D c b7 to= <br /> gR . °° <br /> further accept all liability that may be a resultof the County of Burnett relying on this Information I am providing in this :v t N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have oo <br /> access to the above-described premise at any=reawnabiea for the purpose of inspection. w N w n <br /> 9 CCC O y <br /> OWNER'S SIGNATURE Gc �R O W r - Q2 <br /> (date) o, <br /> ZONING ADMINISTRATOR (5 <br /> 60 ew c t7 t21 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS <br /> PERMIT SHALL <br /> ] E'XPIREO///fff ONE YEAR FROM DATE O(FISSUANCE <br /> /VJ k I is-` -(') <br /> O <br /> (/ to OOO OO <br />