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� ] <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator = <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE Y <br /> r� Ln...as�- �,s -3 -7581 = d <br /> MARJNG ADD ;,' <br /> I s <br /> 95�S l N. M k [! l .lk R A . S1 rem- 4lT 54 C?,) �i }�—J <br /> PROPERTY ADDRESS <br /> I <br /> LEGAL DESCRIPTION c C r'�yo' 'q= Lj (=30' <br /> TYPE of PERMrT(S): SINGLE-FFAMILY DWELLING 91 ADDITION A DECK ❑ GAUGEIACCESSORY STRUCTURED IS <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS O FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ - e <br /> l/ P 1. MI.'( `�Oam ' U` <br /> STRUCTURE/ADDITION USE: 4�.�i�Z� �.f2E/V. 02 -r <br /> (Home/Cabin;Commercial Blmness;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: -e�IF <br /> C 3 <br /> z <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/a X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS <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. - <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW d <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). '=1 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S) R j <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. 1� w` <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES I <br /> TO BUILDINGS,ROADS, LAKE,LOT LINES. M <br /> S. 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 ( , <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 J C <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d 'F C) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. h O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r-- <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> J p > > os <br /> I declare that this application(inducing any acrompanying schedule)has been examined by me and to the beat of my _ o �. <br /> _ .�.. <br /> knowledge and belief It is true,correct and complete. Iacknowledge that I am responsible for the detail and accuraq of all <br /> G <br /> information contained in this application(inducting anyaccompanying schedule)and ifurtherdedarethatl recognizethatthis °. > > G �, , <br /> information I am providing will b,relied upon by the County of Burnett Wisconsin in determining whether to issue a Permit. I <br /> further accept all liability that may he a result of the County ofBurnett relying an this information s am providing in this a c <br /> application. I agree to Permit counts officials charged with administrating county ordinances or other authorized person to m <br /> have access to the above-de abed premises atony reasonable time for the purpose of inspection. <br /> OWNER'S SIGNATURE 7-C - - B n -= � - - ' <br /> (date) <br /> ZONING ADMINISTRATOR <br /> - - <br /> TOWNSHIP PERMITS MAY BE REQUIRED = - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> � C8 " moo <br />