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b z <br /> � o <br /> a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> o <br /> 0. <br /> OWNER 1•,9 ELEPHONE��C �� K <br /> (�Tjf71L! C7 �f� O <br /> MAILING ADDRESS 87) I <br /> PROPERTY ADDRESS �C ,,✓ `�O r a <br /> ITRL r ni9?Aj&)At, L.19 <br /> LEGAL DESCRIPTION ccaa>C /r S' <br /> �7a �s ✓ �'a s Pte,.Gat✓.[.a r o �a-s�33 -fx�-z� �, <br /> TYPE of PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTUR <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ ' <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ ' . <br /> 0, r <br /> STRUCTURE/ADDITION USE: J/��rT ��A � N o1XC[' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) � <br /> BUILDING CONTRACTOR: CLA_­AJtG- Z <br /> � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. k: <br /> f a �( <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) q w <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �; <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW G, c <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <br /> AND INDICATE NORTH (N). o V) Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) 5' ° <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK p0 <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. O <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THEw <br /> lW,' w <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. `1" � �11�ii!VV� <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 111 <br /> 0 <br /> NEEDED. I r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:~. In ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z V' <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. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER VY <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 /> 2. > r) L) > ro <br /> R n y 3 3 3 �re' c � ts1 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of myg o,°�� „ 9 9 g 0 A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all S, ' m d 2. rn .j <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this 9 m Y <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I w ? e' ii c= <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 <br /> have access to the above-de gibe premises t any sonable time for the purpose of inspection. B B ➢ <br /> W u O <br /> OWNER'S SIGNATURE Zvw — /O//A 2 -21g' �o g g H <br /> �[ 6 O HI <br /> (date) LIEU D m n :. <br /> Q � . z <br /> ZONING ADMINISTRATOR <br /> MAY232Q <br /> TOWNSHIP PERMITS MAY BE REQUIRED '- <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAIWNNETT COUN <br /> ZONING ��� s <br /> 0000� <br /> r <br />