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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Offlce of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERV\ fq In C S / /'r '7 6 ^ Imo.` /4 ^ C/< TELEPHONEg7 d <br /> J J o ?: <br /> 0 <br /> MAILING ADDRESS 20 —7 0A k ( 66rt�� Qo 66 V ) 963Yp <br /> PROPERTY ADDRES b2'7 \ fvJw1 <br /> �y <br /> OA /< c Akc: VA. WE i3S76R Wl . <br /> LEGAL DESCRIPTION <br /> Oc, Lot 1 304-0 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE �- <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> I— <br /> v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITIO ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ 0 3 O <br /> STRUCTURE/ADDITION USE: ♦'� c RJ <br /> (Home/Cabin; Cono3iercial Business; Bedroom; Deck; etc.) r@ <br /> BUILDING CONTRACTOR: Dw AI L-R h <br /> Q <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G o <br /> WILL BE RETURNED. m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m C7 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (ES)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, c <br /> AND INDICATE NORTH (N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w' <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. nS' rn <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 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 <br /> NEEDED. n O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <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. �A <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. <br /> NOT TO BE USED FOR HUMAN HABITATION... � <br /> 6. �7 <br /> m 1 1`JQ.. 5 j57f Grl"'1 m <br /> 7. $ ;0 > r)nnp > 0 'C <br /> I declare that this application(Inducing any accompanying schedule)has been examined by me and to the best of my B 0 ,Z e ? w 3 <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 <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 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described remises at any reaso able time for the purpose f inspect n. ' P, a w w N w n <br /> OWNER'S SIGNATURE nc� i y9^m <br /> (date) o oB <br /> T <br /> ZONING ADMINISTRA Jim Flanl�ar) 9 ' <br /> .0X. <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> ,10e1mf v �e �rnail� fvJe(vtsT�a s o00og <br />