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z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y: N <br /> {� s <br /> OWNER /'�_ I(' f5 L1 A/b1"PC,O/t / TELEPHONEn/�j-- <br /> L// / <br /> MAILING ADDRESS\2^� �� �0L / <br /> J ,I l 7 <br /> PROPERTY ADDRESS I g(j <br /> LEGAL DESCRIPTION V v V T k0T I /�� —'3g-17 <br /> 0 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION L7 DECKA GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO L7 STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT 0 <br /> ro <br /> COMMERCIAL BUILDING 0 SOO�MMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ 5' <br /> STRUCTURE/ADDITION USE: �C�lit\. c <br /> (Rome/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O o <br /> WILL BE RETURNED. <br /> � g <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. G O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW by <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O v <br /> AND INDICATE NORTH(N). J z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS) , o <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ' <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. O <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. 5. <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 1 0 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. �( I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN -i <br /> NEEDED. ` <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: fV�1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. s > o 0onc b <br /> nn R33 cc = "rd <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my g o a n n 0 <br /> knowledge and belief it is true,correct and wmplete. I acknowledge that I am responsible for the detail and accuracy of all �' • W 5 : y <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> -. o DbJ n+ <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I d a a v : .9U. <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this ya d, <br /> application. I agree to per it county officials charged ith administratlng county ordinances or other authorized person to p != : o: g S <br /> have access to the abov escribed <br /> premises a ny sonablo time for the purpose of inspection. > : w 'A w ry <br /> y <br /> OWNER'S / 3 pogo oo � <br /> SIGNATURE ( ) U In n y9 a <br /> date o <br /> om <br /> 20NING ADMINISTRA ORfTl T tal')I923q <br /> TOWNSHIP PERMITS MAY BE REQUIRED r u` <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �N pN Vii� t�ii O <br /> y i p O O O O <br />