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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE a <br /> MAILING ADDRESS <br /> lo <br /> ?r] 1., )1_V +Ve 6 iOa,,,( 5�ID V v <br /> PROPERTY ADDRESS OF n <br /> G� lP L�J o 1 <br /> F1 <br /> LEGAL DESCRIPTION r. <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ' rn <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING 0 CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ `�° <br /> r � <br /> STRUCTURE/ADDITION USE: CSM e — e <br /> (Home/Cabin; Vommercial B siness; Bedroom; Deck; etc.) <br /> 3 0 <br /> BUILDING CONTRACTOR: 3 <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m '' <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 m w 9 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 0 9 9 <br /> AND INDICATE NORTH (N). CKJ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK WW Q> <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES N <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. SCC_ FQ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE nyJ '� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. V t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. S I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n 7 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <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 Q <br /> SETBACK AREA. _ J <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. o <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> Z• 77 9nnnG] D O '9 <br /> F � nF39El <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 2 <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all d- m'rn <br /> c �. D <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a pem <br /> that this D > a= <br /> further accept all liability that may be a result of the County of Burnett relying on this Informationrmit. I <br /> Information I am providing In this o 5 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ' ,-�, ,� o o o o <br /> access to the above-described premise t any reasonable time for the purpose of inspection. F w a o w w o o y <br /> y <br /> OWNER'S SIGNATURE <br /> nd, y � mno � ,� 0 <br /> ("'//� (date) E; <br /> o n o = Z <br /> 91 <br /> ZONING ADMINISTRATOR \ Jllh Flirtn tq'ar) 7 N a? y o n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Li P6-LI 777-?n <br />