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6 <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator y: <br /> APPLICATION FOR LAND USE PERMITS s <br /> its- s��- `149 a <br /> OWNER CXi,,'k S f� _`' TELEPHONE ��5��. 35� •2d r�O <br /> MAILING ADDRESS 1 D6 Ccs., •1.-t `�� S'Q � wy —,�( I— <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION lava of 6;.,. F4% S <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDIRON ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> �I <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S <br /> (n� z <br /> STRUCTURE/ADDITION USE: ��LOl Soy X 72 0 _ <br /> -^ , ((Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR:Y V C>��\ rRaV <br /> A o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. rn <br /> n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. �+^. w " n J <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, N a W <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)��11LDING S)TO ALL LOT LINES,(B)BUILDING(S) <br /> rn fFNTFR iN OF Rnen (C)BUILDING MEA UR MENT(S)TO ORDINARY HIGH WATER MARK o <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. s <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES �, C <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE <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 <br /> NEEDED. <br /> r I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. H z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 7' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. C <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. T o 0 0 o C] Dao ^C <br /> n N333 � L: <br /> H 2 o m m m o '� G <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 <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 a = a m N : 9 <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m c ?acv . -d <br /> further accept all liability that maybe a result of the County of Burnett relying on this information I am providing in this a 5. : N o No 'C <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to m <br /> have access to the above-describe remi s at any reasonable Sime for the purpose of inspection. <br /> > <br /> OWNER'S SIGNATUR ALZ <br /> (date) <br /> ZONING ADMINISTRATOR F c J y o n R�'7 <br /> 3 H � C ' Fiim <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8; . <br /> d2 :: d <br /> t�ii VNi 00000 <br />