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c Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITSN <br /> 'o' <br /> 7j5�3�>/9 X9 -- <br /> 5'� k\ <br /> OWNER ��J�� <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS ��•• � '� � ��� <br /> LEGAL DESCRIPTION L–I <br /> TYPE OFPERMrr(s): <br /> SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> ro y <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> �G <br /> STRUCTURE/ADDITION USE: LI(i Vit, QN'eu {7�QfLhltu <br /> (Home/Cabin; mmerci— a�s; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �f,y' i. <br /> n <br /> O � � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. r,.i�• <br /> v FT- G )tt <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) Cy <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. E. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW to ro 3 <br /> BUILDINGS/STRUCiURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, W c <br /> AND INDICATE NORTH (N). N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <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. d C' <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. v, <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 p 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 C <br /> NEEDED. y <br /> U� R, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z <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 <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. r) na ro <br /> a � <br /> zo333 _. <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my 3 F <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 `° —__. > w N <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I w a v w b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this w' o No rro" <br /> application. I agree to permit county officials charged with administrating co ty ordinances or other authorized person to <br /> have access to the abov -d scribed p ises at any reasonable time fpr th p rposedf inspe on m a i {„v,w C1 <br /> /sp ti l �j /� (A W W N <br /> OWNER'S SIGNATURE " �..�-/..rfi� / \-�P�� �r /j� ' / (/D 3 Oil � � $ 0 0 0 o I� <br /> N 6 <br /> _ (date) n sn nq. <br /> V1 c a: ° 3 S <br /> ZONING ADMINISTRATOR �� (VI� ����� < <�I Q� � �:: ''�a. �� � by <br /> f o � SL) M <br /> TOWNSHIP PERMITS MAY BE REQUIRED y " <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> � N00000 <br />