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0 v Z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS N <br /> y w <br /> O C <br /> � R <br /> OWNER �jl'nn Y1n �j �v/v1C TELEPHONE <br /> MAILING ADDRESS ' I ' ! VV 1n ��� <br /> r� <br /> PROPERTY ADDRESS <br /> o S <br /> � d <br /> LEGAL DESCRIPTION <br /> TYPE OF PERPUT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ ^ , <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ �J <br /> COMMERCIAL BUILDINGG ❑ //C�OMMERCIA[�LL ADDITION ❑ COMMER/ICIAL AACCESSORY STRU�C�TURREn❑�{, <br /> STRUCTURE/ADDIRON USE: Ln la-`CIL tcdaorn -K), 1 1 er6('r1 i9 `� (iCrGO/p`S 'Z S <br /> Home/Cabin;Commercial Busi ' Bedroom; Deck;etc. o <br /> ( ) (lY'Ya5' Q 'room t I&'Y/6�5 'C�ack\ <br /> BUILDING CONTRACTOR: je7 <br /> n � <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G o_ <br /> WILL BE RETURNED. •� <br /> � n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCRIRES(EB)AND ALL NEW py 3 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <br /> AND INDICATE NORTH(N). c <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. G 'A Q.D <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES c 0 OG <br /> TO BUILDINGS,ROADS, LAKE,LOT LINES. 5. <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 "3 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 7d <br /> � � r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. v <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y <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 <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, T ~ n 0 0 0 P 6 <br /> 3 <br /> i declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge F, ? o°> <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the Countyof Burnett Wisconsin in determining whether to issue a permit. I further accept all <br /> •e n w V <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to n <br /> permit county officials charged with administrating county ordinances or other authorized person to have accessto the above- p .� 8 g <br /> described premises at any reasonable time fo he purpose of inspection. °� 5 8 8 w N w <br /> OWNER'S SIGNATURE —c" CV <br /> (date) o a P3 g G <br /> Tm F�CcnrO,ah oos � s e <br /> ZONING ADMINISTRATOR n <br /> ' H w ' <br /> Ry O'^ o = o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> J N N tin �Vii <br /> /q' d !�-/4o— ma/Zed '-o -Th onvu <br /> ✓v'`� '7 3� 8 <br />