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v z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS a 3 <br /> OWNER ptTELEPHONE l5Z d <br /> TE� Gnru.sot� cT kL- ° �`tG 35ZZ <br /> " o <br /> MAILING ADDRESS 4LA7-$ CAryL bp VE: rX 1N1JeToNuA M 565'45 --�' <br /> PROPERTY ADDRESS ZG' 7�7�9 F700-p evpt> TOWN of 3R(,a5on) .� <br /> LEGAL DESCRIPTION PGL IN 6oV LOT Io � � <br /> AW J7-OR-Z-4o-IS-oI -S <br /> TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING L1ADDITION ❑ DECK ❑ GARAGE/ CCESSO UCTURE ❑ <br /> BUNKHOUSE 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ T <br /> S 1i+ <br /> �o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> !7 a 3- <br /> STRUCTURE/ADDITION <br /> STRUCTURE/ADDITION USE: 6 JN✓•44 S E o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: O W tj 6-14- <br /> A <br /> tiA PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 0 _ <br /> WILL BE RETURNED. <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m p <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 NEW0 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 'B <br /> AND INDICATE NORTH (N). y Z <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 ,5 <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 _ JU <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. - r <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 ..� <br /> NEEDED. r a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z b O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. to <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. Ul <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> ^ pyaaoro <br /> 2. <br /> H Z a m a 3 0 0 E <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my a 0 <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all m <br /> information contained In this application(including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be re/th <br /> he C my of Burnett Wisconsin in determining whether to issue a permit. 1 w < b <br /> further accept all liability that may bunty of Burnett relying on this information I am providing in this <br /> application. I agree to permit countwith administrating county ordinances or other authorized person to haveaccess to the above-described preminable time for the purpose of Inspection. <br /> = 6 0 0 0 o y <br /> OWNER'S SIGNATURE o a o 3 0 <br /> (da e) _. O <br /> ♦ ♦ _ .-i .�j. S 9 T. H TI <br /> [� t� <br /> ZONING ADMINISTRATOR O� n ( -t C A <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti <br />