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i v z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 4 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> v � <br /> OWNER TELEPHONE <br /> MAILING ADDRESS I-j-'/ �( �WX <br /> PROPERTY ADDRESS .JrJ D <br /> r71g(� I� DT'Wc leo kWV IJP <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION D DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS D FILLING/GRADING ❑ CAMPING UNIT ❑ ,5 I� <br /> COMMERCIAL BUILDINGr/00� COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ _ =9 <br /> STRUCTURE/ADDITION USE: 11 U2CiV...�J I T�4.JT—Vl, k) <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR:'' <br /> ^ CJO ("'SSSS <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 ch X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS a <br /> WILL BE RETURNED. s �� <br /> ti <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW s r <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). '� z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) Q (y d <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK m U <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES gyp,�l <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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 s' <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN W I_ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G (C <br /> (n I <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> fn <br /> NOT TO BE USED FOR <br /> Joe 2 2HUM/A`N�HABITATION.6. C,y <br /> 7. = 'lJDc 1 ^ ?> Oti <br /> :. M, 233 & m <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detall and accuracy of all <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this => . <br /> '9 c ',`� <br /> D <br /> Information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Informatlon I am providing In this r'; -c <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described piMm at any reasonable time for the purpose of Inspection. o ,� ;;, v, [� <br /> LL L gyp" C 3 <br /> OWNER'S SIGNATOR \U,1-t <br /> Wim_ F ch z r 1 M <br /> ZONING ADMINISTRATOR _ <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />