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c Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a f 1 <br /> APPLICATION FOR LAND USE PERMITS y <br /> OWNER C N ¢(`1 j� TELEPHONE �3�ji� , <br /> VVV TTT'T 6'E' �\ 9(I tJ <br /> MAILING ADDRESS <br /> I035 1'Vl e:ctir�( Shorev.ev lMn Ss►zic�, � a <br /> PROPERTY ADDRESSW <br /> 'LL10-7 ( a,r�e^ lee D Zh`x.�� (v. SW513 0 <br /> LEGAL DESCRIPTION Cly Tl1 <br /> _7On RI-jw Lill z- l.-�•, Vi PJo( � <br /> / A, 4.-Vj Jor 3J S <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRAn+DIING 0 CAMPING UNIT B� W E <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED Ip c CA <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) �\ <br /> BUILDING CONTRACTOR: r� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <br /> C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW ' <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, +y <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) 8 CN P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S Ql� <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. ty <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES 9..J <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 7D <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y 91 <br /> NEEDED. <br /> v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'A <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. <br /> 7. �- � � o 0o pn9.0 � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all M m v = = a y <br /> information contained In this application(including any accompanying schedule)and I further dedare that I recognize that this E. a m ,`O ; <br /> information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I ,�, p.m <br /> v i : rd <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this Na y L' N It <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have 8 <br /> access to the above-described pre s at any mesa bie time for tqe purpose of Inspection. <br /> h Y <br /> OWNER'S SIGNATURE - � 'Q �d a a <br /> (date) <br /> Qa m rn ++ O <br /> G = Z <br /> ZONING ADMINISTRATOR �/ ti d o �, y a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C N H <br />