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i = <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator = <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERl TELEPHONE Q <br /> / r✓wotEt'T =J. 1 A(_� HSI) G26-6Cx� -1 <br /> _ W � : <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS d 0839 <br /> fl ^,tea, lnt�� <br /> f OAKN <br /> LEGAL DESCRIPTION d,Y/,i/ oM !'�,M,veTCn, <br /> T 3 C R 7F37i� L; f4 / 17 J D �•35331ti,. z 6Lz ,�irw 9 S tA <br /> TYPE OF PERMIT(B): SINGLE-FAMILY DWELLING ADD ON DECK RAGFJACCESSORV STRUCTURE' <br /> BUNKHOUSE• 59.692(1V)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE <br /> STRUCTURE/ADDITION USE: (.a 4/)AS%ro2n!-P. (� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ]V! <br /> c <br /> BUILDING CONTRACTOR: />%.GZ2�z- -' �J�I.LSS/If S Zd`l4 Ski rk S— _ <br /> A PLOT PLAN MUST BE PROW DED ON AN 8'h X11 SHEET OF PAPER. ANY M <br /> INCOP ETE OR ILLEGIBLE PLOT PIANS — n <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) _ Y <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL COSTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). z <br /> EA <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) o 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. J <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 Cy <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 R 1 ti <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. 4- <br /> THIS <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: E} c <br /> -1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. OI 0 z _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 3- <br /> 3. NO GRADING ORS N (J) <br /> ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING <br /> RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER !� <br /> SETBACK AREA. (CJ} <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> T <br /> I declare not this application(including any accompanying schedule)has been examined by me and to the best of my ro j 3 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all K — - - —1 <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> information I am providing willbe relied upon by the County ofBurnett Wisconsin in determining whether to issue a permit. I — <br /> furtheraccept 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 <br /> have access to the above-described p mazes at any reasonable time for the purpose of inspection. <br /> OWNER'S SIGNATURE l• I <br /> (date <br /> ZONING ADMINISTRATOR 5 D U LL- In m <br /> TOWNSHIP PERMITS MAY BE REQUIRED SEP 1 6 2013 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF I NCE <br /> BURNETT COUNTY - <br /> ZONING <br />