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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a �4 ° <br /> APPLICATION FOR LAND USE PERMITS 7 <br /> o <br /> OWNER TELEPHONE <br /> t' Vy. 1in&k . 1A1 �vSl � 7 <br /> Tr f9 � e <br /> MAILING ADDRESS <br /> Po 1� r__ e_s-� o—l�Cis� 5 �fmg (�1 oQ R <br /> PROPERTY ADDRESS /-5✓7/� <br /> (�-' <br /> LEGAL DESCRIPTION c <br /> /a 5E SC <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 4e ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 :n <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0_ COIMMERCI�AL A�CC��DSSORY STRUCTURE ❑ <br /> A <br /> STRUCTURE/ADDITION USE: l� <br /> nes <br /> (Home/Cabin; Co ercial BusiT,rBedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: J <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81P2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C0 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n '' <br /> m O <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 m w �°-' o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH (N). 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 Q o' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. A� <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES Q <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �j r <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. Q <br /> NOTE: BUILDINEEDENG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN C, ...I ((O' vl1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. —(.. z Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C' CEJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER gj N <br /> SETBACK AREA. �. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. W <br /> 7. 77 9rlor] pa b <br /> z � � 000 � 4 m <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my g c 2 <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> infonnatlon contained In this application(including any accompanying schedule)and I further declare that I recognize that this o E. a a m N <br /> Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I 4? E > c W= <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 <br /> �° <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. o d o 0 <br /> OWNER'S SIGNATUREto n <br /> 9AM7I9�AOAAAIY c 6 0 0 0 o y <br /> (date) o a <br /> ZONING ADMINISTRATOR J ry�r I b1an(v <br /> oRC) CH <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEt:o N N N o <br /> 4viry(+4 [2+-er Plaed LLP b( � !l )OrlcTrefsuer 8-10-11 1 � <br />