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g <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator = <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER " U/47 �7,� �jy/L TELEPHONE ;71 g�� 7Q6 � , \ c7 -I+r <br /> LJi�/—I / G /T J <br /> MAILING ADDRESS i/7 / �/!s" b R� J/ /1 46 U 2; W I \ I \ <br /> PROPERTY ADDRESS D 67'4TAII!3 ✓12�', w I 1W1� rn <br /> LEGAL DESCRIPTION n II 7 � \lr�lyyls <br /> TYPE OF PERMITS): SINGLE-FAMILY DWELLING ADDITION 11❑ DECK 3 vIGAAUGEIACCESSORY STRUCTURE ' <br /> —1 = <br /> BUNKHOUSE Cl 59.692(1V)GAZESO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 .' <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> SIRUCTURE/ADDm6A'TIs °' 6 �GG �S�on; C 2 I�mSTjLUGT1�/Zg <br /> (Home/Cabienial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: �o' <br /> AP LOT PUN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> r <br /> DIRECTIONS FOR PLOT PUN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. P <br /> 2. SHOW THE LOCATION AND SIZE OF ALL DOMING BUILDINGS/STRUCTURES(EB)AND ALL NEW O c <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, _il <br /> AND INDICATE NORTH(N). a' z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) TF <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETUND AREAS,AND(D)LOT DIMENSIONS. 4e. <br /> 9. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES e <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. — <br /> 5. 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 50 AN ONSITE VERIFICATION MY BE DONE WHEN V' 'i L <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> L DRIVEWAY MUST MEET DRWEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. pi <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, <br /> 9. 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. yp > n _ n0 > c — <br /> gr�i333nysi <br /> 5 3 A <br /> Idedthat application any accompanying schedule rt has been examined by me and to Me haof my g o z <br /> knowledge and belief it is we,mrrM plate. T acknowledge Nat I am responsible for Me detail and accuracy of all <br /> inrormation contained in Mis aDDlita ' <br /> clings.,accompanying sMedule)and I furtherdeclare that l recognize Matting _ > <br /> information I am providing will be lin Pon by the county of Burnett Wisconsin In determining whether to issue a permit. I _ _ S <br /> fntheracceMallliability Mat result of Me county of Burnett relying on this information l am providing in this _ m' 5 — _'^ `d <br /> application. I agree to permit c ofcials charged with dmimvinatlng county ordinances or other authorized person to _ <br /> M1ave accessfotheabove-0 premises at any reaso a le tlm eppr of inspection. Y ' u (] <br /> NL' , <br /> OWNER'S SIGNATU 3 n u a o <br /> (da � u >'� <br /> ZONING ADMINISTRATOR SEf—�—�— 3 D n _ F F e •'� <br /> Z�z '01 T V, M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS .€TT COUNTY <br /> ZONING _ <br />