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y b z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS y <br /> i � <br /> OWNER TELEPHONE <br /> k (" de- (old 3-7�l 3795 w <br /> MAILING ADDRESS 3yiq 2Fa11'l i Axjy- S ����� M (J '55` l kO �I <br /> PROPERTY ADDRESS I w5 inkUtL <br /> LEGAL DESCRIPTION PCL6oy bot 'OtL <br /> TYPE OF PERMIT(S): SINGLE--FAMILY DWELLING At ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ m <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ J� A <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r <br /> 0 <br /> � ✓ <br /> STRUCTURE/ADDITION USE: c7 e-- c T, � <br /> (Home Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Ct '.1 <br /> lil "i er ,�. 1C-(,n,,,1� 3 l ir-d•� )mak C+ le 'qdGe "S� o <br /> A PLOT PUN MUST BE PROVID0 ON AN 8 rfz X11 SHEET OF PAPER. ANY INCOMPLETE'OR ILLEGIBLr PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m a <br /> I. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. e d <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, (; v <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) g <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. <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. <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT 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. <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. <br /> 7. annnnaoro <br /> A � 993 ,��, aA M <br /> I declare that this application(including any accwnpanying schedule)has been examined by me and to the best of my 3 ? 7 9 9 ' w <br /> knowledgeand belief R is true,correct and complete. I acknowledge that I am <br /> P g responsible for the detail and accuracy of all m d , <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this —E. D 9 m `c � <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the county of Burnett relying on this information I am providing in thisc ;,,;,, n^ ,°; b <br /> application. I agree to permit county officials charged with administrating county ordinancesor-oThec-euthgifeQ ye <br /> access to the above-described premises at any reasonable time for the purpose of inspection / S w w�r) <br /> (( 1� <br /> OWNER'S SIGNATURE a o W p tl <br /> r1C,T3 (dit8 �' , � ���_ _ °� x - <br /> ZONING ADMINISTRATOR <br /> � ' to <br /> RIURNC77 .aOi.SNTV R - c " 7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED `i ��� rr "` <br /> THIS PERMITSHALLEXPIRE ONE YEAR FRJOMI DATE OF ISSUANCE <br /> ��/ �''�,L 1 '{' �l���.{� /' ' tel.� �✓ C( I � .���I�h:C i r".'�� �"'� ^�� r v% �l.�y� ,J., u 8 0 0 0 0 <br />