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Z b z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER �O r /' � r n �� _ J TELEPHONE d <br /> MAILING ADDRESS 2_7 <br /> i/V1 D S 151-12 L <br /> PROPERTY ADDRESS / 0f3 0 l <br /> f SDN )5- Al <br /> LEGAL DESCRIPTION 1 3 0-L ✓, g P 6 OJT"-T Z-t, 3 5 c L.g <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE/)K' 4- 9. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ :o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: L-'A <br /> 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. n. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. w �% <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW `C>, o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). pz <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) so 5' <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK IC3°o <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. y7 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 5. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE (f; <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 /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> z <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. <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. Q <br /> 6. <br /> /. an naro <br /> yzo5, - 3oo = � <br /> I declare that this application(Including any accompanying schedule)has been examinetl by me and to She 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 E � m w d. <br /> information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this E. D w N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I d °: a = 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 r (P g i ;,,,<� <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to �r C) E i o i 8 0 t" <br /> have access to the above-described premises at any reason le time for the purpose of inspection. > H w N w () <br /> OWNER'S SIGNATURE 7 I o 0o g o 0 0 <br /> (date) c o? m 7 <br /> 0 <br /> ZONING ADMINISTRATOR 1clan <br /> 0 5 o^p froi7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE `g <br /> S O O O O <br />