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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS H <br /> G N <br /> OWNER _4 jC) TELEPHONE <br /> CJC T l O <br /> MAILING ADDRESS v <br /> '7?55 lYllna,- Ln N . ��Ilwa¢e� 5568 <br /> PROPERTY ADDRESS --LOS 8c, <br /> LEGAL DESCRIPTION c Q <br /> y <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE. <br /> 4- <br /> BUNKHOUSE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ J' <br /> ` 9 O <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑. COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: GLS e Z <br /> 0 <br /> (Home/Cabin; Comri4rcial Business; Bedroom; Deck; etc.) ��II <br /> BUILDING CONTRACTOR: ti W <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> W 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tnn 0 <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 _ er b 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, c <br /> AND INDICATE NORTH (N). r, Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 J <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. O <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. rn <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 CS} <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER I `a Azo <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHENNEEDE <br /> uN4 r n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I C" fT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n .z G. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a r <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. d <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. (/ <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> Z ^ gpannnnao �a <br /> 2' o oo'S <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 ,� „n o 3 n' ? � <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 .'� E D > m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 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 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. m w <br /> VII / Y <br /> OWNER'S SIGNATURE�_�o� " y� j c <br /> (^ I l (date) 0 <br /> ZONING ADMINISTRATOR �(� r � (�Gln Jo'y o�' E 8 <br /> (To : c as n in <br /> TOWNSHIP PERMITS MAY BE REQUIRED p <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE «"N <br /> -2✓/Y�i-� d- I.e.-�'�Z� PiG�eO( �.�' lo,,� /201 -2r�- �J�(��r,� 1��� r/ � � o a o 0 0 <br />