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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS N <br /> OWNER <br /> �1/I "(i"�/ ( yl G✓�2 y� TELEPHONE <br /> 71 —37,-:—890 6 O <br /> MAILING ADDRESS <br /> I <br /> PROPERTY ADDRESS <br /> 0 <br /> � I J <br /> LEGAL DESCRIPTION_,5W� <br /> TYPE OF PERMIT(S): SINGLE-F MILY DWEL ING D ADDITION D DECK ❑ GARAGE/ACCESSORY STRUCTURE v <br /> 0 <br /> BUNKHOUSE D 59.692(1V)GAZEBO D STAIRS O FILLING/GRADING D CAMPING UNIT D <br /> COMMERCIAL BUILDING ❑//COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> a <br /> STRUCTURE/ADDITION USE: lJ IIS o <br /> (Home/Cabin; Cc mmakal Business; Bedroom; Deck; etc.) }`Xb <br /> BUILDING CONTRACTOR: MM �'..�J� <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS p c <br /> WILL BE RETURNED. ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o p 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. C7 <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. m <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. V I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. � �' y <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: " <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <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. <br /> 6. aft/�1:'/rno 10cv4r»� 7o Se, vevhol Qrfev T 'CR,G�a+... See /clEo' d,£6ncMr(. <br /> 7. a000mdoro <br /> c _— <br /> R a .A <br /> H n <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my g o,°z g <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all c m a r r <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this D a m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I .� �. ,`�,' d w 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this di N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of inspection. m P <br /> OWNER'S SIGNATURE Wlt�7V n 6Li <br /> 0 m O <br /> ZONING ADMINISTRATOR , APR I a <br /> 1611- Ll <br /> x i <br /> TO NSHIP PERM S MAYBE REQUIRED SU <br /> THIS PERMIT SH LL EXPIRE O E YEAR FROM DATE OF ISS UAT3j -'_'NO(J ti o N N <br /> ��IV � ooaoo <br />