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C ° <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator OGJ <br /> APPLICATION FOR LAND USE PERMITS y, N <br /> 0 y r <br /> OWNER--1 Ch TELEPHONE <br /> / flour aS —� Sit Sci.x. 1, r �i"f'er�Ceri (J'I <br /> MAILING ADDRESS /� / <br /> Q0 L)h' fie� ield br'v Oo.Auq� MN 551a `i <br /> PROPERTY ADDRESS <br /> S1 1 <br /> a171,9 Scen;c_ VierI Lane ` onr,ei bj1- 511901 O <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE. (n y <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> A <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r <br /> STRUCTURE/ADDITION USE: R. r 'Z <br /> (Home/Cabin; ommercial Business; Bedroom; Deck; etc.) <br /> w ��J <br /> BUILDING CONTRACTOR: n � <br /> O � � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rfi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ �) <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C d <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, Q p <br /> AND INDICATE NORTH (N). I N Z <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 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <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 /> S. 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 1 o G <br /> PIANS MUST BE SIGNED AND DATED BY THE OWNER. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. 1 Qjy <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: QO O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. I n Zcl <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER n , <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. <br /> 7. n o e e O n 0 b <br /> I declare that this application Indudin an accompanyingschedule has been examined b me and to the best of m $ <br /> PW ( g Y ) Y Y 3 0'2 . d". 2 � ? w' <br /> knowledge and belief lt Is true,correct and complete. i acknowledge that I am responsible for the detail and accuracy of all d y d d P_a . <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .^0 5. a 9 m N <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 c '� in in'�'`✓',`^, 'd <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 premises at any reasonable time for the purpose of Inspection. W N c f) <br /> 6 <br /> OWNERS SIGNATURE awn/ a6da�I A) A y 0 $ 8 0 <br /> Oy > 2wn] vi_m 0 <br /> (date) e $5, <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> J 4n OOO.00 <br /> ��rm i � � Jam'-12����ed d%p by vc(Sav�C-hrlS�nsen 6-a�- lQ <br />