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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> �, r ks6n <br /> MAILING ADDRESS/3,;/n l_I t)� �brr� �. <br /> PROPERTY ADDRESS 7 `/M1MA �� \ <br /> ITv p <br /> LEGAL DESCRIPTION ( OUV,V OF /A�GtiL I <br /> w ifs P 8G 115�- 39- 17 <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK 11 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ nnCOMMERCIAL ACCESSORY STRUCTURE E3o <br /> STRUCTURE/ADDITION USE: CS' 6VdQp stx7VaDe 'UVI��(nCa ,� / X <br /> (Home/Cabin; ommercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. p — _ <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW w o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK E. <br /> (OHWM) <br /> FLAKE, STREAM OWETLAND <br /> 4. SHHOWHEELOCATION OF THE WELL (W)SEPTIC TANK (ST)AND DRAIN IELD (D)I AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. rtrt I <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. Iy1` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: M' <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 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER y 1 <br /> SETBACK AREA. V <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. pyannnna � <br /> r n g 3 RI 9 2i TJ <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my c ' <br /> knowledge and belief it Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all <br /> Information contained In this application(including any accompanying schedule)and 1 further declare that I recognize that this a 5. a a m N <br /> Information I am providing will be relled upon by the County of Bumett Wisconsin in determining whether to Issue a permit. I .� 2 <br /> L <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this 9 5T. <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have 0 174access to the above-described premises at any reasonable time for the purpose of Inspection. 8 i 8 N n <br /> OWNER'S SIGNATURE -� �-1 ---- Z�,�J A lig g <br /> ndo mnd � 2 <br /> "(date) <br /> ZONING ADMINISTRATOR_ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE „^ <br /> � � 00008 <br />