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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 <br /> OWNER �4e v�� TELEPHONE <br /> 11�C <br /> m <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> l v LL>Y o <br /> LEGAL DESCRIPTION o <br /> V <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 39 ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING [I COMMERCIAL ADDITION 11COMMERCIAL ACCESSORY STRUCTURE 11/' o B <br /> STRUCTURE/ADDITION USE: � o <br /> (Home/Cabin; Comtnercial Busi s; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: .41,40,5' ekmorey fia solar Z n5rirr� C <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y2 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) QRI <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. rn O J Q <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, v1 c v <br /> AND INDICATE NORTH (N). o i 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 Ei <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. v, <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. Jv <br /> \ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 9j1 <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 z <br /> 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. d <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. n <br /> NOT TO BE USED FOR HUMAN HABITATION. :E t�J <br /> 6. <br /> 7. o o 0G� D� O `O <br /> 3 5 E_ <br /> I declare that this appllutlon(Including any accompanying schedule) has been examined by me and to the best of my 3 0,°� B S ? wo 3 <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 o E-a D m <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I .°< g ?w .Dp <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <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 premises at any reasonable <br /> time for the purpose of inspection. 3 > o 0 0 0 8 <br /> OWNER'S SIGNATUR CC - 18�(2— � fD °'a <br /> r nsna �.mr) pm� C <br /> (date) <br /> ZONING ADMINISTRATOR <br /> n _ <br /> TOWNSHIP PERMITS MAY BE REQUIRED A ° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N N o N U o <br /> 00000 <br />