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N b z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator < _ <br /> APPLICATION FOR LAND USE PERMITS <br /> ° n o <br /> a <br /> OWNERp ^ nn'„^ ��� i r lC TELEPHONE b J <br /> „ LLJ KJl =% <br /> MAILING ADDRESS 0 i `' (),s e K`- o Od O r. Ea �,n m/V s5/ <br /> `7 <L�1L VV JJ C-tel ` <br /> 0 1 <br /> PROPERTY ADDRESS <br /> Sr) 6q,.q <br /> J <br /> LEGAL DESCRIPTION (, <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITIONDECK❑ GARAGE/ACCESSORY STRUCTURE❑ E. <br /> 6 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> �v 3 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> IIhYI z <br /> STRUCTURE/ADDITION USE: Peviace add deck - 'ST-b � <br /> ome a m;Commercial Business; room; c ;e C. <br /> n <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS \i <br /> m <br /> WILL BE RETURNED, <br /> m T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) y <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW 3 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, .�} o <br /> AND INDICATE NORTH(N). i 2 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) E. <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O <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 <br /> TO BUILDINGS,ROADS, LAKE,LOT LINES. •l. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. G n` o <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 4- <br /> H '� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: GI <br /> x <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C z p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p ` „ <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 /> 6.7. P <br /> � aa ° ro <br /> a _ <br /> I declare that this application(induding any accompanying schedule)has been examined by me and to the best of my 3 0 ,6 r " <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m > w E H <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that thisE. a <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ? c <br /> further accept all liability that may be a result of the County of Burnett retying on this Information I am providing in this = w <br /> application. I agree to perml �u ty o icials charged with administrating county ordinances or other authorized person to <br /> have access to the abo.,d cH !d premises at any reaso time for the purpose of in Ion. <br /> OWNER'S SIGNATOR R g g 8 \ <br /> ^ (date) y n �, Z O <br /> ZONING ADMINISTRATOR I �`��' / Qn <br /> c ao <br /> TOWNSHIP PERMITS MAY BE REQUIRED = " <br /> 2 d, <br /> HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> (�rmi{-� <br /> (M �• N fA 69 bf <br />