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c m o <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> ?. j! <br /> APPLICATION FOR LAND USE PERMITS Z <br /> OWNER / �J <br /> /'J�ialU TY_IA,��a TELEPHONE O <br /> � m <br /> MAILING ADDRESS1 (�� <br /> /03�1y St - �ca. °7 () Clrc�w Ots SL/ n — ; <br /> PROPERTY ADDRESS -3 \ <br /> 39` L, 0 � <br /> 0 <br /> DO <br /> LEGAL DESCRIPTION � T 3Rr 1`7 � <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITIO DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMIERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: �--�`" a <br /> (Home/Cabin; Commercial Busines Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: S� ` <br /> n <br /> I�� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o _ l" <br /> WILL BE RETURNED. S <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 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 w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, c <br /> AND INDICATE NORTH (N). N c <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. O <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. <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.,THEoQ <br /> t o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. UJ Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- <br /> 1. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z rt <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. C, <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 /> Z ryd aaoro <br /> R n ^ 333 � a� tr7 <br /> N z o S <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 ,2 = ° w <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 thisv _ D 9 m <br /> a <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I .� ,��, ao' y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this = �y H w o r C% <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have 6 �1 d Q o o ^� <br /> access to the above-described premises at any reasonable time for the purpose of inspection. ° <br /> OWNER'S SIGNATURE a <br /> ' (date) <br /> ZONING ADMINISTRATOR <br /> v icn � <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^ j <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C o <br /> 0 0 0 0 0 <br /> /I a/ /nV/' �✓ <br /> // 3. oS <br />