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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g ° <br /> APPLICATION FOR LAND USE PERMITS y <br /> H <br /> OWNER G26662� L,-,-6TELEPHONE 7(5- 7Gc> sv3 a <br /> MAILING ADDRESS � 1 <br /> Z J <br /> W10\60 �F4 � ✓Lrsce i/ W� SYoa Ul <br /> PROPERTY ADDRESS Q <br /> %e/+rc uBu�� Cir <br /> LEGAL DESCRIPTION 1 N G p <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURW9Z <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 R <br /> COMMERCIAL BUILDING 0 /COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 S o <br /> STRUCTURE/ADDITION USE: Gar {� �' Z d` <br /> (Home/Cabin; ComtAercial Busines ; Bedroom; Deck; etc.) nom, P <br /> BUILDING CONTRACTOR: L-4eec. � (n r, <br /> O � � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c .. <br /> WILL BE RETURNED. G 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y K <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ht w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, V o <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w O <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 a <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. v, Cr <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 \ o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. OQi <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ..I <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: r O <br /> �r C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z Cj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. !; A <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 5 <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all c, to m a m a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this c R a a ti j <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .� <br /> further acceptall IIabllity that may be rewR of the County of Burnett relying on this Information I am providing In this � �� w N`�`''_^N .0 <br /> application. I agree to permit coun Milt <br /> charged wA administrating county ordinances or other authorized person to have �,2 $ $ <br /> n _ <br /> access to the above-described prem A any reason le time for the purpose of Inspection. ° a 8 8 w N A <br /> 6 $ $o $ $ y <br /> OWNER'S SIGNATOR y <br /> c(date) <br /> ZONING ADMINISTRATOR �_TlM anl/ an <br /> TOWNSHIP PERMITS MAY BE REQUIRED G °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> p t'clt ed itp lb 9 6r.011r: a7 <br />