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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g � <br /> APPLICATION FOR LAND USE PERMITS 11 <br /> OWNER <br /> vv TELEPHONE/G �Al eAj?4 C50V <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS V/ J �ue�Sp��J <br /> / h < <br /> LEGAL DESCRIPTION y - TT _ p 6rchu tH'G'du✓ S <br /> Al SC C70 n) `f' 61;UAS�i, 3y A) 7 k,vG /6 GV eT <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> n <br /> COMMERCIAL BUILDING ❑ OMMERCIA ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' � <br /> STRUCTURE/ADDITION USE: z <br /> (Home/`Cabin; Commercial /Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN B 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANSOZo <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C d <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, v <br /> AND INDICATE NORTH (N). N 1 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 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK(ST) AND DRAINFIELD (DF), AND ALL DISTANCES I ; ' <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5' W <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ,z <br /> 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. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITA ON. <br /> 6. Oyk'5i-� bq Cb7)Yv1�_ l�Ic� 5� IBD n. <br /> 7. �8 - s <br /> 05 • s,- , K o. K. � > avb <br /> Z �' An ,oS' 'A <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my 3 <br /> o o' <br /> o = ? 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 = D D W N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit._I__. - - Cy g a ao <br /> further accept all liability that may be a result of the County of Burnett relying on this Informatlo <br /> application. I agree to permit county officials charged with administrating county ordinances or - p <br /> access to the above-described premises t any reasonable time for the purpose of inspection' a $g o N o y <br /> U $ o <br /> OWNER'S SIGNATUREI—, /// -l^ ( > <br /> ZONING ADMINISTRATOR �./I/p T 'qv/ , l ° y " <br /> TOWNSHIP PERMITS MAY BE REQUIREDqQ <br /> ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N N U N <br /> N U S O O O S <br />