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y 9 Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 7 <br /> APPLICATION FOR LAND USE PERMITS <br /> DO <br /> OWNERT � QdJ UA� vi3� �N TELEPHONE/_C' �" v, <br /> MAILING ADDRESS 13o d% ?rot_ , )0 • C.u,� c L (J�( „,� ( rYT�� � <br /> Iy .]0 .1 a Ivv" JJ � AJ <br /> PROPERTY ADDRESS A <br /> LEGAL DESCRIPTION 5,e,k <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 (� <br /> r <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ ° <br /> STRUCTURE/ADDITION USE: t_Gt�OI I c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: r-Fhur lY iS� 0 <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN B%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PUNS o N <br /> WILL BE RETURNED. c G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m 'a <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 <br /> BUILDINGSJSTRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Cep p <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)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. 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. S m 1 <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 C,� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. -�J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- C J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z C3 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 HABITATION. <br /> 6. <br /> 7. sq � o o o�aoE MV <br /> J <br /> F 7 n <br /> I declare that this application(Including any accompanyingo m schedule)has been examined by me and to the best of my 3 e ,0 a, 3rt = ? w <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all R to m m= <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this .� `- c m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit Ih d w` . '9 <br /> further accept all liability Mn <br /> at may be a result of the County of Burnett relying on this information I am providing in this s c in N : �',", '9 <br /> application. I agree to permit county officials charged with adminlsti atlng county ordinances or other authorized person to have ^ d <br /> access to the above-described.preLnI es at any reasonable time for the�tu of inspection. <br /> \ 3 K7 y o g o 8 g y <br /> OWNER'S SIGNATURE <br /> (date) g F 9 2 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED h ` <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N�^ <br />