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� z <br /> a <br /> G Z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator S <br /> 11 <br /> APPLICATION FOR LAND USE PERMITS 0 <br /> a <br /> OWNER LEPHONE O <br /> r o <br /> MAILING ADDRESS /(/( C n �,w _1 r t <br /> `[`(`J L �L/ (1( 1 <br /> PROPERTY ADDRESS Lk) 61 <br /> f� In <br /> LEGAL DESCRIPTION , i C) (Y, <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ,ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE ?. <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ ,o <br /> COMMERCIAL BUILDING EICOMMERCIAL ADDITION 1:1COMMERCIAL ACCESSORY STRUCTURE 11 S <br /> /- � Z <br /> STRUCTURE/ADDITION USE: 1„Q Qr n Q Q&A f-4 e7 .77 tl <br /> ome in;Commercial wsines; Bedroom; DeC ; MC.)BUILDING CONTRACTOR: PtI e-VtOO CA2 h2lt 60 1, G rnn <br /> 3 <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS (n <br /> WILL BE RETURNED. " <br /> 6 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. =° <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW cis o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, �I <br /> AND INDICATE NORTH(N). p �` 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. / p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 4 <br /> TO BUILDINGS, ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE V" <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 -3 <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. 8 v 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. O r <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER lam\ <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• bEr'vc6we io be: <br /> f <br /> , or FvrElw keH' 6b. 71J'� SeaS6IcX. AlmAa3 adtLlslrt by <br /> 7. <br /> Burns& Cn*.*Y 4,aw} ' 'D o3 0 o H a O 't <br /> N 3 3 9 o a m M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my p 2". <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all dC y <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I ? H ii w'= : 14 <br /> further accept all liability that may be a result of the unty of urnett relying on this information I am providing In this w y d,= 24 N 'ro0 <br /> application. I agree to permit mon is har K Inistrating ordinances or other authorized person to ^ O " ' o ? .r. <br /> have access to the above-de d pre at y le time Pose of inspelc�tion. 9 D g W ti <br /> OWNER'S SIGNATURE,/ <br /> rr <br /> (data) _ Z <br /> � a : c <br /> ZONING ADMINISTRAT 1Z �" o x ^ �? .n <br /> TOWN HIP PERMITS MAY BE RE IRED I <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g <br /> IJ <br /> �� O O O O <br />