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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y <br /> o <br /> 6 <br /> OWNER + r oete- .� TELEPHONE o <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION r' <br /> 0 <br /> TYPE OF PERMMS): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE ❑ C .. <br /> 0 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ d <br /> a ' <br /> COMMERCIAL BUILDINNG ❑ COMMERCIAL^ADDITION ❑ COMMERCI LLACCESSORY STRUCTURE ❑ a9jSTRUCTURE/ADDITION USE: ID &_Ck L4 0 b <br /> (Home/Cabi ; Commercial �o <br /> Business; Bedroom; Dec ; etc.) _j nF <br /> BUILDING CONTRACTOR: ( / A77th CLIA 'v <br /> n� <br /> �ar1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. G <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m O O <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 LTi w 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH (N). N c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 p <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. t7 ^ <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. cn O' CS <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I}1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. C> y <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: r- <br /> 1. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r) Z C� W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. nnII <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER H I G <br /> SETBACK AREA. 6 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Cr <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. &-(x r)Crf Q++o_Gd"w_d f-b koTiiz • E <br /> 7. q D o 0 0 ° d 9 -0g 2 3 3 3 a n <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my g F, <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m d = rn y <br /> Information contained in this application(Including any accompanying schedule)and I further dedare that I recognize that this .� o.> a a ti <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I .c 5- a ?as <br /> further accept all liability that may be a result of the County of Burnett relying on this Inforrnatlon I am providing in this <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�y rea nable time for the purpose of Inspection. <br /> yc0000 � <br /> OWNER'S SIGNATURE G'TW l—L `--tY �'� t, n 6n D W d <br /> � date) <br /> ZONING ADMINISTRATOR �JIf f,�y�/ F ido uG)O n <br /> mac : darn <br /> O s <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE -N " <br />