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y � z <br /> d <br /> � o <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator N' <br /> APPLICATION FOR LAND USE PERMITS a a <br /> a <br /> OWNER TEO <br /> Tul) ( 5 ung LEPHONE� � �Pu Uurnf <br /> (0 <br /> MAILING <br /> MAILING ADDRESS 1 R, C„T 5 P �I-_�_��.vJI <br /> > fD <br /> PROPERTY ADDRESS o <br /> 3f1�s5 c2�f jtie (f La l!�, lam/ S�/K 7/ <br /> s <br /> LEGAL DESCRIPTION <br /> ti <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ?. <br /> m <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> rIts <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> I <br /> STRUCTURE/ADDIITON USE: �.()0od S hF o <br /> Val <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �f aV I S (JQ /Y Q�.1�{�0'0 <br /> � c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 C7 0 <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 <br /> AND INDICATE NORTH (N). o Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) o (y <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <br /> UQ <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 1 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ` _ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. w^ o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE 1 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. - __Z) l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 7' d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. a y z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 7' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ) y <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER VJ <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. <br /> 7. <br /> Hz "s � � � oo = z <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 ,� _ R e ? <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 _. a <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I d i? e wV 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 g : L'N 'O <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to o o [" <br /> have access to the above-de Ei <br /> at any reasonable ' e for the purpose of inspection. > u Nom„ f7 <br /> 4 mR Y <br /> OWNER'S SIGNATURE <br /> (date) j &s >� m n Q m 2i <br /> ZONING ADMINISTRATOR ' o 2' :" o^ -.1 <br /> p � w : <br /> TOWNSHI ERMITS MAY BE REQUIRED d O H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g ' <br /> t o O O O O O <br />