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m P_o 0 <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE C, �WAp¢lr .2 0�6 <br /> MAILING ADDRESS <br /> o <br /> cH _V1, i - <br /> MSN R-ya� NEr �, <br /> PROPERLY ADDRESS O <br /> LEGAL DESCRIPTION �� •• � <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION DECK GARAGE/ACCESSORY STRUCTURE `- `4- <br /> C 4 <br /> BUNKHOUSE• 59.692(1V)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT :L <br /> a <br /> COMMERCIAL BUILDINGCOMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE <br /> z <br /> STRUCTURE/ADDITION USE: STo,p.v�`i La <br /> l <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: �ACTEQ$ /�V/4 G7/A-rcGS n <br /> C, 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <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 o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). o z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) 6' 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. c o Q <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES RI <br /> n 0 P <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. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> 0 <br /> NEEDED. p C Qj <br /> THIS PERMIT IS SUS)ECT TO ALL CONDITIONS LISTED BELOW: r �' r— VI C, <br /> r l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z jv <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F' - <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 93 <br /> SETBACK AREA. W <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> s C <br /> NOT TO BE USED FOR HUMAN HABITATION. _ d <br /> 6. <br /> > nr) Co > ow <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 �, y dHRL <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this 5. = > N Y <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I c a a= <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this a d, <br /> application. I agree to permit county rials charged with administrating county ordinances or other authorized person to O m- o o o r <br /> 5 ^ > : o o <br /> have access ro the above-described ises at any r nable a the purpose of insp�e�cppt'on c <br /> OWNER'S SIGNATURE �' ,� T �� <br /> (date) rn us > <br /> / <br /> ZONING ADMINISTRATOR � �Cu1(,Ian <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS <br /> RanPERMIT <br /> -4-t- W446/-"E�e�1 fz ONE �RGCr V-s 6- iVirOM DATE Of <br />