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C Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS H <br /> a <br /> OWNERTELEPHONE ° <br /> C�rr�,`s SAH Pz a <br /> MAILING ADDRESS <br /> .., Z SGn nAr —T 4 C a ° <br /> n <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION67 <br /> S' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ U) <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> STRUCTURE/ADDITION USE: 3n X(to �, 2,EJ '-9,, H�(d���4r.._ Z <br /> (H me/Cabin; Comme lal Business; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: 17ftle <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILIFGISLE PLOT PLANS G o_ <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C 9 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW t��f 9 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, b <br /> AND INDICATE NORTH (N). z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (8) BUILDING(S) ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK w' <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <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. JZN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 0 1 <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. 3 <br /> l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n �s <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. ¢ <br /> 6. <br /> 7. ° 7C > 88o p > 7 <br /> declare that this application(including an accompanying Z $ <br /> is- <br /> 1 <br /> PW ( g V perrying schedub)has been examined by me and to the best of my o '81, R. <br /> knowledge and belief R is true,correct and complete. I acknowledge that I am resporeible for the detail and accuracy of all py 5 5 y <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize Mat this E.°> > U1 N <br /> Information I am providing will be railed upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I 5 ,r'a5 <br /> acceptfurther all Nobility that may be a result of the County of Burnett relying on this Information I am providing in this c <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ^ " 88 . <br /> r <br /> access to the above-desalbed premises at any r�sonable me for the purpose of Ins 8 8' A <br /> Inspection. ° R o N w w `�'w Y <br /> // � aeW ��7ltilg <br /> OWNER'S SIGNATURE 1��..Gt/u� date) g g�c�./M Z <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti N N <br /> ,� �, 80008 <br />