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b o <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> p iJ <br /> OWNER n <br /> / II I� II TELEPHONE r to <br /> o <br /> / G <br /> MAILING ADDRESS <br /> 7- <br /> Sr� W <br /> �( 4 I L <br /> PROPERTY ADDRESS <br /> Xx o��� �a o <br /> LEGAL DESCRIPTION SZ3 n 40,1V T 17 r..l <br /> �.of 3 GSM rso r/cl 1 P4yr_ /SD a l5"9/87 °r <br /> TYPE OF PERMIT(S). SINGLE-FAMILY DWELLINGV ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ v. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIA/L ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ 'p%p <br /> STRUCTURE/ADDITION USE: ov�.c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.)LMIUJ <br /> BUILDING CONTRACTOR: C 6w5 rk YortMts SOS (,jCSf ,4✓c <br /> IZ c� Ltilr� , wr Soy, 68 c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) k C C s <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 M <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) sN J o GJ <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. O <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. S. �D7 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. v, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE <br /> 141, <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 'w <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 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. I G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r <br /> O <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. E <br /> 7. ^ > 33o 00�a£ <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my a '° 4 o w <br /> knowledge and belief It is true,correct and complete. I atlmoydedge that I am responsible for the detail and accuracy of all g m 2.2. 2.a <br /> Information contained in this application(Including any accompanying schedule)and I further declare brat I recognize that this '° .a a m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In deMminkg whether to issue a permit. I m c R $a N <br /> further accept all liability that may be a result:of the County of Burnett relying on this information I am providing In this <br /> application. I agree to permit county officials charged with admi county person to have <br /> access to the above-described or the purpose <br /> nto inspection.c ordinances or other authorized <br /> premises at any reasonable time far the Purpose of InspeWorr. <br /> OWNER'S SIGNATURE <br /> —z (date) <br /> ZONING ADMINISTRATOR Jt n r-1 <br /> 8 : Ecu n I <br /> TOWNSHIP PERMITS MAY BE REQUIRED p .. <br /> THTS PFRMTT SHALL FWPTRF ONF YFAR FROM DATF OF TSSIIAN . C�6 <br />