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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator r <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERw'Ilia <br /> / TELEPHONE 2. <br /> ��s- 8� - voy <br /> l /um ( �ru/n. � '/5/0 <br /> J / [�o'/� o <br /> MAILING ADDRESS .D `339 ^ Ce �.I (��GUY� &)T s /4�lD f 1 <br /> d. 1. N / \ <br /> PROPERTY ADDRESS <br /> ///��� <br /> LEGAL DESCRIPTION �, �• t <br /> TYPE OF PERMIT(S): SINGLEEFAMILY DWELLIPk❑ DDMON❑ DECK 0 GARAGEIACCESSORY STRUCTURE 0 ' n <br /> BUNKHOUSE 0 59.692(IV)GAZEBO 0 STAIRSY FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 3 <br /> STRUCTURE/ADDITION USE: .S`1 Q/YG✓gl/ /u �/-J��(J - <br /> ome/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> z <br /> BUILDING CONTRACTOR: Se I C <br /> 0 <br /> r <br /> r � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/t X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. - <br /> DIRECRONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) - <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. u <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, J -� <br /> AND INDICATE NORTH(N). - <br /> 3. SHOW DIMENSIONS IN FEET OFTHE 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 g <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <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. - SU <br /> S. INDICATE IF A WALKOUT BASEMENT 15 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 50 AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. <br /> THIS PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW: u Imo' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n N <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 O <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. S <br /> 7. 5��rw �ZJ CJe liLl�J(JGe /'UUIG z > r.nn ^,> c � <br /> Ideclare that this application(Including any accompanying schedule)has been examined by meand to Me best of my <br /> knowledge and beliefit is true,cormctand complete. I acknowledge Mat I am responsible for the detall and accuracy of all 5 <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize Mat this n <br /> information I am providing will be relied upon by the county of Burnett Wisconsin in determining whether M D Issue a permit. I _ — > <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in Mis _ <br /> application. I agree to Permit county officials charged with administrating county ordinances or other authorized Person to <br /> have access to Me above-described premises at any reasonable time fir the purpose of inspection. 3 >' . as NOF) <br /> OWNER'S SIGNATURE o g= g o <br /> (date) <br /> ZONING ADMINISTRATOR T pL r i 3 <br /> TOWNSHIP PERMITS MAY BE REQUIRED E�a'U-G�UNTM IxlgM <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU ZONING IIS_, <br />