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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS bsl s: <br /> OWNER TELEPHONE AW K3(,- <br /> ,I, CL/�ce �10.n FUYc / s «I_ 271 -z3 �S <br /> MAILING ADDRES - V � <br /> / �z(n ( S� l Pa DUI l UQG1 SI i ]�o�q <br /> T <br /> PROPER �qD/'ty o_ r-an h e.r-ry L-Cc.r)e ban�.oC V1/ <br /> LL ``�1 / o <br /> 1 <br /> LEG L DESC IP ON r <br /> l�;a .� u l nt 9 /ion, inferes� puf lvt I <br /> TYPE(F+ERMIT(S) SINGLE-FAMILY DWELLING O ADDITION O DECK O GARAGE/ACCESSORY STRUCTURE O <br /> BUNKHOUSE O 59.692(1V)GAZEBO O STAIRS O FILLING/GRADING)( CAMPING UNIT O <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE O o m <br /> s R�`�sF�"J r Er cAr) I rip Y-6t-p Shr re.&ne 0 z <br /> ( oma/Cabin; Coma3hrcial Business; Bedroom; Deck; etc.) �).- ems�n <br /> BHf6DMG CQNTRACTOR: e e-n �_Cb-)lh7 GLL C.-I"1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%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) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <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, Q p <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. i p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 9 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. l� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q <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. Qom- l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <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. n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. w <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. iL <br /> 7, '; 0 > n n o ndoro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of myo R R ^o ? w' <br /> knowledge and belief It Is tore,cortect and complete. I acknowledge that 1 em responsible for the detail and accuracy of all m � = a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this a E.a Y m N <br /> Information I em providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. 1 w a" g a Y <br /> further accept all liability that may be a res of the County of Burnett relyI on this Information I em provitlinq In this c '� y ;.,H .`�='N b <br /> application. I agree to permit county offk cherped with Istrad my adinankxs or other authorized person to have <br /> access to the above-described premises any reasonable r the OuIiIIose of inspection. w <br /> pga80088 > <br /> OWNER'S SIGNATURE 3 <br /> � 0 <br /> d PdXg = z <br /> ZONING ADMINISTRATOR <br /> JUL 1 201 2. w <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCfURNEjTC <br /> . NN 69 fA W/ <br /> OJTY� N000011a/ <br /> ZONING \�V// <br />