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C N Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER a LU <br /> TELEPHONE Ifs- &� <br /> p <br /> MAILING ADDRESS Sac} -,n r S4. rt <br /> so <br /> PROPERTY ADDRESS Q -7y&a <br /> LEGAL DESCRIPTION <br /> LOJCI Gsm /, � a 3 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION O (DECK O GARAGE/ACCESSORY STRUCTURE 1 <br /> BUNKHOUSE O 59.692(1V)GAZEBO O STAIRS O FILLING/GRADING O CAMPING UNIT O <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE O c <br /> STRUCTURE/ADDITION USE: / Rle, c <br /> (Home/Cabin; Commercial Business; Bedroom; Dec etc.) <br /> BUILDING CONTRACTOR: �<4,_ <br /> n <br /> as z� Cc .1-2 �, GYkffL ,, r� , sy�ya 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET F PAPER. ANY INC PLETE OR ILLEGIBLE PLOT PLANS C 0 <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. C O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW tr <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) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O Q� <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <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. `I <br /> Vv <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> � � I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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, O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. 0 <br /> 6. F I <br /> 7. apyaononop > 0 -V <br /> " 33v^ 6 K7 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my o ? w' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this Y <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 accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at a easona le time for the purpose of Inspection. 3 ;I > g o 0 0 8 y <br /> OWNER'S SIGNATURE Dc' /3 a a <br /> (date) <br /> 'i1 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> U � 80008 <br />