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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a P <br /> APPLICATION FOR LAND USE PERMITS <br /> � y <br /> OWNER TELEPHONE O <br /> deb Sal' �Crr/ �/�h���Ct�Sf77/?z n 6 _ <br /> MAILING ADDRESS (��d N H �c/_.r) La�Ce �� ✓Jah�7l�'!a VCCI <br /> PROPERTY ADDRESS <br /> '7aao Nh <br /> LEGAL DESCRIPTION c Cb <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> a <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ C <br /> COMMERCIAL BUILDIN/G/ ❑� COMMEyR-yC�IAL ADDITION CI COMMERCIAL ACCESSORY STRUCTURE El <br /> STRUCTURE/ADDITION USE: L-C.f2-{� Di, I/I�QGIe o <br /> (Home/Cabin; Commercial Busine ; Bed m; Deck; etc.) � <br /> BUILDING CONTRACTOR: N <br /> n pW) <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) rr'n 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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O 3 <br /> AND INDICATE NORTH (N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) P <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. 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES I J) <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 4, :n Q) <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., THE i <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN G) <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. ( n Z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �I y p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ll�ll�C5j <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. o 0 o u a 0 7 <br /> A " <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 A ? w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a m mL ELL E a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this a 5. a a M N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I A 'c t <br /> further accept all liability that may be a result of N County of Buynett relying on this Information I am providing In this <br /> application. I agree to pernR county ncl s rha ed with istratln9 county 999yy���dinances or other authorized person to have <br /> access to the above-described premises ny ason t far the purpp5e oyinspe tk g. <br /> ao oo <br /> yacg000y <br /> OWNER'S SIGNATURE z <br /> i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OFIS UANCE <br /> m� �»^ <br /> Pe� f l ekes Pad( cop � web �,W� 8!e io <br /> � � S000S <br />