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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS : N <br /> / s <br /> OWNER t , � /� TELEPHONE <br /> O <br /> MAILING ADDRESS � <br /> X103 r4s7 /" nh6rs16WAbs7er <br /> PROPERTYADDRESS _'— <br /> 1 <br /> LEGAL DESCRIPTION xw 5--o z-/ ®o ci <br /> C- T - Z- - -v2 Z60 <br /> TYPE OF PERMrr(S): SIN E-F MILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE ur <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING O CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ <br /> COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: CZ <br /> ZB;(HoCBNS <br /> sil <br /> BUILDING CONTRACTOR: O f f o <br /> .z <br /> e r i Lr( WT <br /> n <br /> rn N <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN B'ft X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> ry <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <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, Ca .o <br /> AND INDICATE NORTH (N). J N z <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 w <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DO,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 S <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. _ a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ((it �N1 cr <br /> NEEDED. (y-i I "'I C�J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: UI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z 1) y Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O w <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. C) <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. 5 � `F° � � B � aE L�1 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my ° '.°° w <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all m _; m �O <br /> m : H <br /> information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this ,o E. 9 9 m ;-� : <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I °' _c. °'E rP <br /> — i <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this m y 7„d,= 1 N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have f° C] o o g 8 „r"„ <br /> access to the above-described premises at any reasonable B e he purpose of inspection. o d o w <br /> m w � tiw > <br /> ae ySoogoy <br /> OWNER'S SIGNATURE - .9 26 <br /> (date) <br /> o sn Ya: m Clp � (,nz <br /> ZONING ADMINISTRATOR <br /> n C w <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N „ <br /> � � 00000 <br />