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C V 7- <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ° <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER C' aid .u- W1f( rh l � &&ZUlTELEPHONE -7/5' <br /> m <br /> /1 R <br /> MAILING ADDRESSgB,//9 ( ' kd'- .1� j?Zgq -z,, uQr s�,� `" <br /> 1 <br /> PROPERTY ADDRESS Sa.vne <br /> 15-50-/6 <br /> LEGAL DESCRIPTION d <br /> N Q �'i+ �a S�C50 6 N (o o/a vim( u) 331 s <br /> TYPE OF PERMIT(S): SINGLE-tFFAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE � (O <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL A DIT ON COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: � ( z <br /> (Home/Cabin; Commercial Busi' ess; Bedm; Deck; etc.) P ' <br /> BUILDING CONTRACTOR: <br /> n <br /> sf y <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 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. <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, v <br /> AND INDICATE NORTH (N). �] <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) � t <br /> �' <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK aR. <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 DRA!MFIELD (DF),AND ALL DISTANCES .. � <br /> -i 0 BUILDINGS, ROADS, LAKE, LOT LINES. �_ ,N 1 <br /> 91) <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. T " <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ff l'. _q <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 8 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 f� O <br /> SETBACK AREA. 11 �d <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. <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief It Is true,correct and complete. I acknowledge at f am responsible for the detail and accuracy B <br /> Mcy of all m <br /> Information contained In this application(including any accompanying schedule)and I further declare Mat i recognize that this <br /> Information I am providing will be relled 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 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 R <br /> access to the above-described premises at any reasonable timme�for the urpose of Inspection. p m p 8 w 8 n <br /> � 1 �C/L (/l �C1►� -l�✓��d13 ' A >3S$oS8 >y <br /> OWNER'S SIGNATURE i 10 <br /> (date) o g <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE t3;:;>v»«» <br /> 180008 <br />