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C O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g w <br /> APPLICATION FOR LAND USE PERMITS N: y <br /> N <br /> 5 ry <br /> OWNERL< � TEL PHON a <br /> Jv rrl 5 f usa v /7nell ��-238, 2�Yt� oho <br /> MAILING ADDRESS /?„ , &&} 24 mAJ 55 /2,5 <br /> I J <br /> PROPERTY ADDRESS � �` ] , O 3 <br /> 2 7��r3 /YI nw+pSo� A -? m <br /> LEGAL DESCRIPTIONj O ^ 7+p� J UGdV G6{� 5 y oaa ,may 141" G 4 <br /> TYPE OF PERMIT(s): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GA GE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO'g STAIRS O FILLING/GRADING ❑ CAMPING UNIT 13 o <br /> COMMERCIAL BUILDING ❑ C/OMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> m <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) R <br /> BUILDING CONTRACTOR: UVC•yr�c.. /V tiT Cun S'I«+s'-�t--t� <br /> n <br /> o � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCQMPLET"E�O"R"IILLLEGIBLE 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. O n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW03 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Ei <br /> AND INDICATE NORTH (N). N r o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) °o C Q <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5. <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. ty <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES G' <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.,THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. VI <br /> � O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. L\t` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z O <br /> 2 REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. w O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a LA <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. _ <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. kA <br /> NOT TO BE USED FOR HUMAN HABITATION. C <br /> 6. <br /> 7. s > 03 0 0 n c 4 �l <br /> 1 declare that this application (Including any accompanying schedule)has been examined by me and to the best of my 3 0 51 R R $? w C+ <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all <br /> information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this n 5. 9 9 to �s <br /> Information I am providing will be refiled upon by the County of ett Wisconsin in determining whether to Issue a permit. I R a w'� [ <br /> further accept all liability that may be a result of theCou <br /> nty of um relying on this Information I am providing In this y N <br /> application. [agree to permit my officials charged wiVainistrIng county ordinances or other authorized person to have �° n o o : g access to the above-described mises at any reason purpose of inspection. ..w <br /> c <br /> a$ c <br /> OWNER'S SIGNATURE —7/ 1 <br /> (dat o 6A c o n ur r <br /> �iY Fl Gcn i gG�n � <br /> ZONING ADMINISTRATOR CA <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE =N <br />