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C I rt z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator �N <br /> APPLICATION FOR LAND USE PERMITS <br /> a a <br /> OWNER <br /> ba Lep <br /> z TELEPHONE O <br /> MAILING ADDRESS ( Q <br /> PROPERTY ADDRESS E5 p(.L v)vi <br /> LEGAL DESCRIPTION 33C>O <br /> / �4 !l_ Vello� 1'gk or)_Dao-3Il OIC (gyp <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTUR <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ r <br /> o z � <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ ° <br /> a <br /> STRUCTURE/ADDITION USE: <br /> (rl0Me/U,aDln; Lommercial Business; Bedroom; c ;etc.) <br /> BUILDING CONTRACTOR: <br /> c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAIIS_ <br /> WILL BE RETURNED. 'n <br /> na <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C w <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 p � _ B <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, (� p <br /> AND INDICATE NORTH(N). p o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) p� <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. <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. ) 0 1 <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 I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. is, <br /> "— -3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN D `' <br /> NEEDED. F C <br /> THIS PERMIT IS SUB]ECT TO ALL CONDITIONS LISTED BELOW: (J) L �. <br /> Z S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. (�J x <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 V <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. 77 a o o d c O ro <br /> 7. y 3 3 3 G <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my y rp N : y <br /> knowledge and belie!it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all c c a c p Y <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to have a permit. I m : c c <br /> further accept all liability that maybe a result of the County of Burnett relying on this information I am providing in this o <br /> permit to agree county > <br /> pi <br /> application. I a ' f1 <br /> g p My oKclals charged with administrating county ordinances or other authorized person to have <br /> access to the above-described prremmiises t n asonable time for the purpose of inspection. 3 r o y <br /> OWNER'S SIGNATUREW��� n a c p <br /> I (date) <br /> ZONING ADMINISTRATOR JImC <br /> �17 <br /> c to av <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> Z! <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N o <br /> PQ(mi } vL Ie--def- Led (,Lfo %l6rLj W 1D al-ll \ oo <br />