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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; Ob <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER /' TELEPHONE <br /> �T _ o <br /> MAILING ADDRESS 6,2� rYIA,,uA <br /> T`_6/S�/'j/ �2jsil <br /> PROPERTY ADDRESS TID��I �p��fft ys I,.•,W£gST � 5- 93 <br /> lD C Y n t <br /> LEGAL DESCRIPTION / o-r <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION Cl DECK 0 GARAGE/ACCESSORY STRUCTURE 0 5 <br /> BUNKHOUSE 0 59.692(IV)GAZEBO 0 STAIRSX FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITIONC'0'�.1 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: J � ' <� I QI�LUaLA �J L�V�. <br /> ((H'ome/Ca1,r, mera.l Business; B!ZL. Deck; tcJ II— <br /> BUILDING CONTRACTOR: SLr L n <br /> o S <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS se <br /> WILL BE RETURNED. O g <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n C) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. - n� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW nI <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, R ty}J <br /> AND INDICATE NORTH (N). 11 w <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) Yl�. <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. c 4- <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES c y <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT 15 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, IA) y <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. 1 V <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN _ O <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <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. a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER [}vim— rlrpryJ15y <br /> SETBACK AREA. 1. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOHUMAN H ATION. <br /> 6. MAY tv, <br /> 7. mann no Qom <br /> I BeCero Nat MIs appt s;Mn .correct <br /> orre t any at plot.. I ae rleche)Nes been examined by me e d to the be4 of my <br /> Imow nitro and btllef It k true,rma o and mining a i ac ompanyin Nat 1 am rand IW6k ter ed retM t I aaprary at all m E`o, a <br /> Informatlon t am providing <br /> In NIM applltatlon BnoluGNq any County <br /> of nyeq tWinwoschedule)and I further EeCare Ma[1 rbass,ae Mat. I H = s a m !, <br /> Infther aon I am luowMnq will a rallied upon of Me County f Burnett Wl Ing on In gttcmlary aI am pr y Lave a hly 1 <br /> ruMer adept all agree <br /> tliability MM may ty o rewlt of h e County M Burnett relying coo ty Nis apnoea or o I r I idnodUng In MIa i} °� <br /> appliwgpn. 1 agree fa penntt urM11 at Its Ua9eE Is aEminktraBnq wanly oNlnanCez or other autNOHutl Person M Gave = m.Z 8 <br /> acted to Me a6oy"a..rn p mle6 ata raamro le Bme far Me purpose of Inspection. m w 0 <br /> Utz �j e68g�8ay <br /> OWNER'S SIGNATURE as+ ^+� - a P_ _ <br /> ENZONING ADMINISTRATOR .y ^ ° 0 M <br /> nc: dam <br /> OWNSHIP PERMITS MAY BE REQUIREDMAY 2 3 2014 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS E <br /> v�5`MY/ BURNE7000 <br /> �- --- ZONING <br />