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3 W <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERprTELEPHONE \ u <br /> ,�c wG� l3 �n.a�{cw 7�/3-Z/aa'> f�= _ <br /> MAILING ADDRESS `/'S// l- TI_ 0 m ^SGN ��\/ ` / 1 A <br /> PROPERTY ADDRESS ;) 7,51(c,/ ISG 1/ _. l h omo wAi Fp j <br /> c 'f LEGAL V-- <br /> DESCRIPTION / / ? / /J`M / /n �-1`nom�� /T D �36/ �y(]�� t2 1SI�J <br /> TYPE OF PERMITS): SINGLE-FAMILY DWELLING❑ ADDITION❑ ' D�BLK ❑d- GARAGFJACCESSORY STRUCTURE❑ <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO Q STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ I� <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: Ll U/h Are�I /y <br /> T- (Home <br /> /Cabin; Commercial Business; Bedroom; Deck;etc.) W <br /> BUILDING CONTRACTOR: I T � r <br /> z j <br /> AP LOT PLAN MUST BE PROVIDED ON AN 8 4a%11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS - j 'G <br /> WILL BE RETURNED. <br /> r <br /> DIREFOR PLOT PLAN DRAWING: (A TOP VIEW) <br /> L.. ALL ALL REQUIRED DIMENSIONS OR DISTANCES CE$TOO BE SHOWN SI DRAWN RE SCALE. r' <br /> 2. SHOW THE LOCATION AND SIZE OF ALL G DECKS, <br /> BPORCH GSAND OTHER S (EB)AND ALL NEW 71 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). G LIC^'` z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDI THE TO ALL LOT LINES,(B) MARK G(5) m' <br /> TO CENTERLINE , ROAD,FC)OR BUILDING WETLAND AREA TO THE ORDINARY HIGH WATER MARK I <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. c <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. G <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. 5 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN C <br /> NEEDED. fA <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> I <br /> L DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <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 <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY, <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. ., F >, c � � <br /> knowledge <br /> declare e and is bellppllwtio e,correct andng <br /> complete. <br /> I ingacknowledge <br /> cowled e)has t I am examined by le r the d todeb t and ac ura y 3 0 ,p a_ �_ _ u ' <br /> knowledge co biied!in <br /> We,correct and(including <br /> fie. I accompa yang sct i am)and I urther Mears debut and accuracy of met _ _ <br /> information wnGinetl in Mis application any accompanying uM1etlule)antll further declare that]recognize Ma[Miz = <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 <br /> application. Iagree to permit county onlcials Charged with administrating county ordinances or other authorized Person to <br /> have access to the above-Eescri premises at any reasorprole time for the purpose of inspection. 3 <br /> OWNER'S SIGNATUR X 7—J— )3 n n N o — ' <br /> 3 n C �., S „i1� — <br /> / (date) w a'7 c n c <br /> � <br /> ZONING ADMINISTRATOR 5 <br /> ✓ v < � C - E T <br /> TOWNSHIP PERMITS MAY BE REQUIRED _ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE O ISSUANCE <br /> 0/USlc�l� `��/U 'l3 Otc 76P� Se��o-'' <br />