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C R Z <br /> Burnett County 7410 County Road K, No, 102, Siren, WI 54872 Office of Zoning Administrator g � <br /> APPLICATION FOR LAND USE PERMITS N <br /> OWNERTELEPHONE - o <br /> Zee &J r �fi' <br /> TG � sl - -Z d <br /> MAILING ADDRESS .. <br /> z �0 3 rpt 7 wore �o kd <br /> tt � <br /> PROPERTY ADDRESS t�.�t.��57ew^� WZ Sv8Y3 G0 �- <br /> S � wIQ <br /> LEGAL DESCRIPTION , ot <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ .. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRSW FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> n <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: A-Te'-9-n, 7�akilt 1-yL <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. — <br /> �n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v i <br /> AND INDICATE NORTH (N). N y Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK p� 5 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. L3 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. A> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ...I v <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: �i ,-. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B <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 N <br /> SETBACK AREA. I <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. f <br /> 7. > 0 0 0 n d l"7 <br /> Hzo � <br /> I declare that MEl <br /> application(Including any accompanying schedule)has been examined by me and[o the best of my 3 0 ,2 g � � ao <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this a 9 D a:— Y <br /> information I am providing will be relied upon by Me 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 information I am providing in this ,,;„ 7 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have a C, o o '. 8 <br /> access to the above-described premises at area n e ti for the purpose of Inspection. a <br /> 3 's1 y00000 <br /> OWNER'S SIGNATURELWLI <br /> Dj LIv. Do: � d� w_n0 <br /> a; aRP — x <br /> ZONING ADMINISTRATOR I r f ! ��(.�J( /'� ; w a n <br /> MAY 12 ZQ11 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS A E <br /> RNETTCOU <br /> ✓n 1�fferrncuteol �o lie � <br /> 6-13-11 ZONING <br />