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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER]�n TELEPHONE <br /> MAILING ADDRESS - <br /> ._.lJ <br /> PROPERTY ADDRESS p�/� <br /> G10 Y'1 nF 1.0.10 ' VV 1II.t IYI <br /> LEGAL DESCRIPTION ' �tI YI YIPS �1QC31 TI(-;✓� �� <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDfTION❑ DECK 0 GARAGE/ACCESSORY STRUCTURE❑ = Z <br /> BUNKHOUSE 0 59.692(IV)GAZEBO ❑ STAIRS❑ FILLING/GRADING 0 CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE❑ <br /> I)v1 I z <br /> STRUCTURE/ADDITION USE: ER P8-R c*, 00 i A -� e/ta fylG e4 Cdl.z[, <br /> ,II (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) _ <br /> BUILDING CONTRACTOR: ftp] N .� <br /> `z <br /> A PLOT PUN MUST BE PROWDED ON AN B'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. - - <br /> DIRECTIONS FOR PLOT PUN DRAWING: (ARIAL OR TOP VIEW) - <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE, r <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, v <br /> AND INDICATE NORTH (N). i <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S) I <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. I - <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. I/ v <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY ANCi,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> OWNER. , <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. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Q Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - z <br /> 3. NO GRADING OR SHOREUND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. l <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. C7 <br /> NOT TO BE USED FOR HUMAN HABITATION. S <br /> 6. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my - ? _ _ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accurary of all - - <br /> informationcontainedinthisapplication(including any accompanying schedule)and Ifurther declare that I recognize that this = = > c ,-^� <br /> information I am providing will be relied upon by the County of BurnettWisconsin in determining whether to issue a permit. I 9: c m <br /> further accept all liability that may he a result of the County of Burnett relying an this information I am providing in this <br /> application. Iagree to Permit county officials changed with administrating county ordinances or other authorized person to np . <br /> have access to the alhove-dem,16iPi premises at any <br /> rrreason le time for the purpose of inspection. ] > <br /> OWNER'S SIGNATURE Vat,,jV <br /> (dare) m <br /> ZONING ADMINISTRATOR <br /> /T <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUN <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING - _ <br />