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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER e / / / .i TELEPHONE <br /> MAILING ADDRESS �i0 / / 4 �, z)z <br /> PROPERTY ADDRESS <br /> /3 <br /> �/ 3/?—yHL�(Y/UA771 , / Ardy ��5��� <br /> LEGAL DESCRIPTION u-30312nM✓/2 / Un /6F _ <br /> 1 _ <br /> _ 1 <br /> TYPEOFPEWmS): SINGLE-FAMILY DWELLING 133ADDITIION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> 5 <br /> BUNKHOUSE ❑ S9.692(1V)GAZEBO ❑ STAIRS D FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ /CMEERRCIAL AD/ArD�I�TI/OWN�❑ COMMERCIAL <br /> AA-CCCESSOORY STRUCTURE <br /> 0 rF <br /> STRUCTURE/ADDITION USE: T,V L'K A/i9YY /X F1 <br /> /O.1_ <br /> (Home/,Cabin, Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h 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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B)BUILDING(S) _ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 1 <br /> (OHWM) OF DIRE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. - <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD(OF), AND ALL DISTANCES _ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. II, 3 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE 5 't <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 <br /> NEEDED. IrFr' 5j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 15 RESTRICTED ALONG SHORELINE. s <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALIS, 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 HABITATIOr!. <br /> 6. fluZ1.DSNa ,von To F_xcBElJ 3S- GT /JEZc,Hr Z-z. Ir7-, <br /> cn > o - <br /> z <br /> I declare that Mis application(including any accompanying scli has been examined by me and to Me best of my j ,'. <br /> knowledge and belief It is We,cornett and Complete. I acknowledge that I am responsible for the detail and accuracy of all u. in _ f- <br /> Information contained in this application(Including any accompanying schedule)and 1 further declare that 1 recognize Mat this ` =r-- <br /> a - <br /> Information 1 am providing will ye <br /> by Me County of Burnett Wlscon9n In determining whether to Issue a permit. 1 w- <br /> furMer accept all liability at mof de unty of Burnett relying on Mis Infonnadon I am proNding In Mis <br /> application. 1 agree to permll fthing with adminLNdUng county oNlnantes or oder authorizes p rson t ave ., = o L <br /> access to Me above-doer bad pfre naNe pme for Me purpose of inspection. <br /> OWNERS SIGNATURE / <br /> ZONING ADMINISTRATOR�`�/..... `.�� 1 Ivzo/ E <br /> rc <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE - - <br /> :s -a 41 <br />