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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS N <br /> c <br /> OWNER /J� J �q/9 L__� TELEPHONE���p//�fjr�yj�S a <br /> /V Yir//O O/olj (�O VV O <br /> v <br /> MAILING ADDRESS �J 16/71 Aw4p <br /> PROPERTY ADDRESS / �I <br /> JQ�YJE <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 10 IADDITION ❑ DECK ❑ GARAGE/AerE5SORY STRUCTURE i v� <br /> BUNKHOUSE ❑ 69.692(1V)GAZEBO ❑ STAIRS ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r <br /> o tZ <br /> STRUCTURE/ADDITION USE: ��2LP J z (f <br /> (Home/Cabin; Commetc usmess; Bedroom; Deck; etc.) P <br /> BUILDING CONTRACTOR: <br /> n <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G o S <br /> WILL BE RETURNED. - Cc <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 w o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3 <br /> AND INDICATE NORTH (N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS) TO ALL LOT LINES, (B) BUILDING(S) 0 <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.' p <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. N I <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. p7� i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN f y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r, <br /> x <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ro I <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. I" <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHI!\'?HE P.EQUIRED':PATER Iw•'\ C <br /> SETBACK AREA. II,_/Ir <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• ^ d a o 0 0 p�p > <br /> x � n 333ID a � <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Informatlon contained In this application(Including any accompanying schedule)and I further declare that 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 a" $ a= <br /> further accept all Ilabllity that may be a result of the County of Burnett relying on this Information I am providing In this q 'moo o Z <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ot" <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. c a O 8' O " <br /> W �" 'g� osa <br /> OWNER'S SIGNATURE 6�2�lD � J i°e a$ <br /> a.o =,� ReTz <br /> I^, (date) <br /> ZONING ADMINISTRATORL((,\ ){m n �Q�((� o C' Lz <br /> n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> U Ni, 0000 p <br />