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b z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a o <br /> APPLICATION FOR LAND USE PERMITS <br /> J cs'i Al <br /> OWNER � plt-LL ✓��1/��/�'NS%� TELEPHONE <br /> /3irn b ir2i! rL 0,c s �° : /i 1A S-5-v 552 <br /> 0 <br /> MAILING ADDRESS <br /> a�sdg (�rr�.r•zon �v v N fu��L�/>r , /yi.J sso�.S 91 ; <br /> PROPERTY ADDRESS n <br /> '?LV-/ U 5,20 9(41 r-PWV )D,,,V t / 17�yyS�.z✓ SUS S`/X30 1 <br /> LEGAL DESCRIPTION S <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ECK GARAGE/ACCESSORY STRUCTURE v t <br /> BUNKHOUSE s 59.692(1V)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT ' <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE S '� <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> /J <br /> BUILDING CONTRACTOR: <br /> O � <br /> "A < <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) [ d <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> /2, SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW c <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). ,� �y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B) BUILDING(5) <br /> 0 <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. yIJ <br /> ,/ 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 5. h <br /> TO BUILDINGS,ROADS, LAKE,LOT LINES. <br /> ,.110 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 1 CSi <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. of <br /> d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN `j Zj <br /> NEEDED. C� <br /> J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: T r- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. HZ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. h z <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 <br /> SETBACK AREA. v I <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. :E <br /> 6. <br /> 7. s > 0 0 0 a £ h�7 <br /> y ' P - -. <br /> z Ella F <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my � o 3 3 3= = ? w <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 `9 E. 9 to N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit. I d o,e a=— <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this Ir 5moo g. <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to ^ o .r., <br /> have access to the above-described premises at any reasonable ti a for the purpose of inspection. c i; a o <br /> OWNER'S SIGNATURE 0 0 <br /> (date) ilr�+ ro o.� •• <br /> Vi <br /> ZONING ADMINISTRATOR D <br /> 17 <br /> TOWNSHIP PERMITS MAY BE REQUIRED s' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUETT COUNTY ; ~ <br /> ZONING C': <br /> $ o 0 8 0 <br /> A <br />