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- z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITSq <br /> OWNER TELEPHONE <br /> MAILING ADDRESS b✓ (0�0 t <br /> 92 f/ �-,�'ar .�✓e LcYT%e� f.f h✓N .SS//Z C ' <br /> PROPERTY ADDRESS / ;� 1 <br /> LEGAL DESCRIPTION rn� •/c 'f Oq,7"/ C2 o ry <br /> TYPE OF PERMIT(SH SINGLE-FAMILY DWEWNG❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUMRE❑ <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO 0 STAIRS❑ HU_MG/GRADING❑ CAMPING UNIT❑ G3 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ ' <br /> r z <br /> STRUCTURE/ADDITION USE: 90. .1c"U <br /> (Home/Cabin;Commercial eugrim; Bedroom; Deck etc.) <br /> BUILDING CONTRACTOR: <br /> z < <br /> A PLOT PUN MUST BE PROVIDED ON AN 8 V.X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. '^ <br /> n _ <br /> DIRECTIONS FOR PLOT PUN DRAWING: (AREAL OR TOP VIEW) _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r — <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW O o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, J F <br /> AND INDICATE NORTH (N). <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 AJ c UI <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. X __ <br /> 4.. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES C, ? 1 <br /> TO BUILDINGS, ROADS, _AKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. vUJ <br /> 6. IF SEPARATE PUNS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC,THE - <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I ISI 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN 111 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. p. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 0 <br /> SETBACK AREA. YV, <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. z ,? <br /> gschedule)has beenexaminedh o '�,, r <br /> I declare that this application(including anyaccompanyin -` e 7I, ^ <br /> yme and to the hest of my ,z B r <br /> knowledge and belief it Is true,correct and complete. 1 acknowledge Mat I am responsible far the detail and accuracy of all — _ _E. <br /> infumlationcontained in this application(including any accompanying schedule)and lfurtherdeclarethat Irecognbethatthis = <br /> information 1 am providing will be relied upon by Me County of Burnett Wisconsin in determining whether to issue a Permit. 1 — <br /> further accept all liability that maybe a result of Me County of Burnett relying on this information i am providing in this <br /> application. l agree to permit county officials charge!with administrating county ordinances or other authorized person to <br /> have access to the above-descdhed pre at an able time for the purpose of insDecti <br /> c I <br /> OWNER'S SIGNATURE �� <br /> D d <br /> ZONING ADMINISTRATOR ' ?r.IPP 1 u <V <br /> TOWERMITS MAY R REQUIRED (a RA COUNTS <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS AnCET m <br /> ZONING - <br /> u s 4 <br />