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� � o <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> o <br /> OWNER ) /J /1 /J` 2 TELEPHONE <br /> so <br /> V;01_ <br /> J_ <br /> MAILING ADDRESS 7�S )�O UC=f"J"-e l �( <br /> tom- 1 � � <br /> PROPERTY ADDRESS <br /> L.V!`moi/✓S��G I'� C,��/ ST��,> o r <br /> LEGAL DESCRIPTION o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING D ADDITION 0 DECK GARAGE/ACCESSORY STRUCTURE 0 <br /> _ <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING D COMMERCIAL ADDITION 0/.�COMMERCIAL ACCESSORY STRUCTURED <br /> STRUCTURE/ADDITION USE: <br /> P <br /> (Home/Cabin; Com tial B ess; Bedroom; ck; etc.) <br /> BUILDING CONTRACTOR: r) <br /> 0 K <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 1 <br /> WILL BE RETURNED. "'i <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m p <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 <br /> fh <br /> AND INDICATE NORTH (N). N C 1 0 <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 w <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. 0 <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. m <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. y X� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> b <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER I <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. (YLuSt �7 ? Ip'fron s z� Lnf /- e and ? 3o' fivm r9h+ way. F <br /> ^ � an � � c aoro <br /> 7. n <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my <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 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I P w' ip <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this c c s,N"22,d'., 7 <br /> access to Me above-described prermit mFamalals Medablehtime�u nun of irdmcectlon.es or other authorized Person to haveOWNER'S SIGNATURE � Lac et o(date)ZONING ADMINISTRATOR IL I� y �' N ` ° F n <br /> +� n C PF' tri <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />