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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator Q <br /> APPLICATION FOR LAND USE PERMITS a a W <br /> OWNER ' n <br /> IS(jC�"4- I q � ,f (�91 TELEPHONE a <br /> MAILING ADDRESS r/�l/_y� 11 ie�r,l For <br /> Q-n / e l /I(�(� Vr6 (e <br /> eJ l� L-V I Jl/ L <br /> PROPERTY ADDRESS <br /> Rear <br /> d r / <br /> 0 <br /> LEGAL DESCRIPTION <br /> r <br /> o <br /> All - <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE w <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS O FILLING/GRADING O CAMPING UNIT❑ <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> STRUCTURE/ADDITION USE: T <br /> 3 <br /> (Home/Cabin; mercial Business; Bedroom; Deck; etc.) - I `� 6 <br /> BUILDING CONTRACTOR: - -G <br /> n (A <br /> 0 3 W <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. <br /> WILL BE RETURNED. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> p - _ <br /> CC, c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n a <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3 <br /> AND INDICATE NORTH (N). <br /> (f <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK (� <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O J <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND ORAINFIELD (DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. _ (f <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE c <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. E <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. (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F z d d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 1I�1 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6 frll C00,5,4'u.(_f toh rp(.t34 M b944 "S Sed �o y zone of�6--" <br /> 7. aoeo aoro <br /> s " . I3nm <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my c C Z' <br /> knowledge and belie!Its[rue,correct and complete. I acknowledge that I am responsible for the detail and accuracy of allInformation <br /> Information I am providing thisined in application <br /> be relied upon by the Couding any nty of Buring nett Wisconsin In determiniule)and I further ngwhether lare tto issue eze that perm t. Is a F E a Y <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this c ' 2 <br /> application. I agree to permit county o als charged with administrating county ordinances or other authorized permn to have m ' «N 8 c g <br /> access to the above-described prem at an�amna me f purpose of inspection. a a « f1 <br /> "/1710? <br /> J / n A �Dg�oS8a3 <br /> OWNER'S SIGNATURE /1 � 0 o H i <br /> a� ; 34c_ z <br /> �f�YYJ ��ttG1G2r� - <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED eu <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE aN»N»»»» <br /> Pe✓fhi, r-leM') _d h k),411 io a��og � � g000g <br />