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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 4 <br /> APPLICATION FOR LAND USE PERMITS r <br /> c�) <br /> OWNER /1L NIS TH4m n_Sn:� TELEPHONES J\ 73 L0/ Y-0 <br /> J � I <br /> MAILING ADDRESS <br /> 3c;7,1 C7/aS �Q x <br /> PROPERTY ADDRESS p r7 <br /> 02 / S / / ZilF)VtlF PJ NE = O <br /> LEGAL DESCRIPTION Z.7j /3 s A, T A, n N )G [A,J Jl <br /> TYPE OF PERMIT(S): SINGLE--FFAMILY DWELLING ❑ ADDITION ❑ DECK Iti" GARAGE/ACCESSORY STRUCTURE ❑ y: <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 I a \ <br /> r0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) tel_ <br /> i <br /> BUILDING CONTRACTOR: <br /> n <br /> r y <br /> C 3 Cx <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ih X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C c <br /> WILL BE RETURNED. — — <br /> T <br /> r, <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 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW T rJ ;'- <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) BUILDINGS) N J Z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ,nom <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETIAND AREAS, AND (D) LOT DIMENSIONS. 0 �1 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES - I- <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 I o <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 I' <br /> NEEDED. _ Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 91C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WRHIN 60 DAYS OF PERMIT. r� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. x <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (� <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> I <br /> 7. n X1 > Inr`C > 0 ^d <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of myq'-- <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a v = m c <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied 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 z G L' �.,`� + <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have17, <br /> access to the above-described premises at any reason leInspection.e for the purpose of Inspection. 6 a w 8 (� <br /> ,>,I <br /> OWNER'S SIGNATURE K� q 2 '� °'c' :j <br /> n > <br /> ZONING ADMINISTRATOR �m Wl,' /(vl[/I '` _ ` `m' : =c tn <br /> S CA:' c � rdtn <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ _ <br /> ►�P �rn t le,+W "tW K�treh�h drn ��09 11 9 o o 0 <br />