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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ° <br /> APPLICATION FOR LAND USE PERMITS <br /> T� y <br /> � C <br /> R <br /> OWNERTELEPHONE <br /> n1 S, -kc,r vv�vy <br /> o <br /> MAILING ADDRESSo� r <br /> ZZSS bb `CO Q <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION c <br /> 4- <br /> TYPE OF PERMrr(5): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE d <br /> }N\ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 13STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT El <br /> 'v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ ? 7- <br /> STRUCTURE/ADDITION <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin; C ercial Business; Bedroom; Deck; etc.) (� yit BUILDING CONTRACTOR: eS' <br /> o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEEP OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � o_ <br /> WILL BE RETURNED. <br /> �\ 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ^— d <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, �} a <br /> AND INDICATE NORTH (N). c o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) ^^ 11 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK `F) <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. cch�ip n' <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 'U Y <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 n` o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. i N <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. W <br /> P <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r) Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B C <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 VU <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. n n o 0 o d y C7 ro <br /> n m B 3 3 N d m <br /> G <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my3 0,°z � �° �; 0, .0w' <br /> knowledge and belief K Is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of all o. I RL R a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this �" °. a a m <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 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-desaibed premises at any reasonable time for the purpose of Inspection. m n w�.j�7, A <br /> c Y <br /> // .m^. p _ 600000 <br /> OWNER'S SIGNATURE` Q�ii I O—S-- 1 CJ yr j <br /> (date) a = 3 d <br /> ZONING ADMINISTRATOR JM F710 r)i Gq G(n <br /> TOWNSHIP PERMITS MAY BE REQUIRED Ei <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> to U O O O O O <br /> [C�'/m� � d le f 1F/ �� c�ed �(�� b� r�c�t_kcrman <br />