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c Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator $ <br /> APPLICATION FOR LAND USE PERMITt <br /> o m y <br /> OWNER Xj <br /> ELEPHQN S MAILING ADDRESS (� �ra�PROPERTY ADDRESSLEGAL DESCRIPTIONwA4 Tv <br /> TYPE OF PERMIT(S): SINGLE-FAM LY DWELLING ADDITION ❑ DECK❑ GARAGE/ACCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: lfb(ho fa /� <br /> t- 1Y1j- � eJ!isfi� z <br /> s� <br /> (Home/Cabin; Commercial Bdsiness; Bedroom; Deck, c.) o <br /> BUILDING CONTRACTOR: N <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 6K- cc O J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y K n <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, ♦ P <br /> AND INDICATE NORTH (N). c ! c <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 O. <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. t7 .9J <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. <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 �. <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 ..� Q- <br /> NEEDED. w (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. fn � <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 I <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. s � a3oogo� aro <br /> fir' ^ 3335^. = <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 detail and accuracy of all a tp! e. <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this E D >m <br /> Information I amproviding will be retl County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that m e a result of th County of Burnett relying on this Information I am providing In this <br /> application. I agree to pennl unty officials chafided with administrating county ordinances or other authorized person to have ^ LI 0 8 <br /> access to the above-des an aso time f r u ose of Inspection. mE 5 n o 5,w w n <br /> (/� 7 Y7 y0000cgy <br /> OWNER'S SIGNATURE a 7� 9°j.ton <br /> —7 (date) <br /> ZONING ADMINISTRATOR <br /> A <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE G« ti 8 <br /> « N= <br /> (erNi,f ��ftei rn lel h� dr A-�k/i2sah '7-/0-e s o o s <br />