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v z <br /> S O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS h <br /> a <br /> OWNER f Q� (� G) �( �v TELEPHONE &SL.• 604- 0y-7tj = o <br /> MAILING ADDRESS BDA Z7Q<131, S, _ PAVL. , MN 57127 <br /> PROPERTY ADDRESS Z 5 rj (7 c> AI` L-Ald-f- 5'4P)N3 CI <br /> Sc-v"TT o <br /> O $-Lj-7- 03 11-0 5,0\ Acffrs <br /> r <br /> LEGAT DESCRIPTION T2Lj!�., 51}LI .SvJ V>65C # 33093 <br /> TYPE OF PERMrr(5): SINGLE-FAMILY DWELLING D ADDITION D DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSECI 59.692(1V)GAZEBO O STAIRS O FILLING/GRADING D CAMPING UNIT 0 <br /> v <br /> COMMERCIAL BUILDING D COMMERCIAL ADDITION D COMMERCIAL ACCESSORY STRUCTURE 0 0 <br /> STRUCTURE/ADDITION USE: PO ir'F— <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: SGL~ n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yx X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 2 <br /> WILL BE RETURNED. <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW 9 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). c 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o J <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. O <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Imo, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE IIrLf" £ <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: r- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 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 /> m o 0 o n <br /> 7. <br /> I declare that this application(Inducting any accompanying schedule)has been examined by me and to the best of my �. <br /> av <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all "01°. - =S a <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this E 3> a a y <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I -y ?w y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information[am providing in this it g N `= b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have q 0 8 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. m wSa §Z'4w N w y <br /> 's1 ry co00 y <br /> OWNER'S SIGNATURE >^ <br /> (date) g a e Z <br /> ZONING ADMINISTRATOR���I�C <br /> � w <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 1 , 800 . 8 <br />