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z <br /> o <br /> S �_ 9 <br /> Burnett County 7410 County Road K,No.102, Siren,WI 54872 Office of Zoning Administrator c c (n <br /> APPLICATION FOR LAND USE PERMITS Z <br /> Oa a <br /> S i qg <br /> OWNER E � ` TELEPHONE 51-2- �?' 6 3, 1 0 Lip .. O <br /> E <br /> MAILING ADDRESS I O� 0 V,�p.,,;i L-a'^`� O� -7cr 7-3,1' S <br /> PROPERTY ADDRESS <br /> 704 e,..�.. '(we�� R1- "• o -� � <br /> ' B^'^ <br /> LEGAL DCIIIPTION cA I q �'�o.rn.A.ox 1 8''^� a 4 7 3 <br /> ESR <br /> TYPE OF PERMIT(S)! SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACO SSONY STRUCRIRE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 ,fir S Q <br /> COMMERCIAL BUILDING Ap01T0[ON 0 COMMERCIAL ACCESSORY STRICTURE 0 V _ o S <br /> STRUCEURFaADDITION USE: Qld.,9.. l"" <br /> nest; � <br /> BUILDING CONTRACTOR: ' 0 3 <br /> % < <br /> A PLOT PLAN MUST BE PROVIDED ON AN a%X11 SNEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE FGIBLE PLOT PLANS a <br /> WILL BE RETURNED. I G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) •O n <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 a <br /> BUILDINGS/STRUCTURES(NO),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, N Z <br /> AND INDICATE NORTH(N). �• <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS) <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WED.AND AREAS,AND(D)LOT DIMENSIONS. m <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 5' <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES- `3 �D <br /> REAS TO BE GRADED OR FILLED. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW Aa (/� E <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, .,THE -� (I) <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. D <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SD AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: fi 1Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Ct O0 <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 1 <br /> SETBACK AREA <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p £ <br /> NOT TO BE USED FOR HUMAN HABITATION. O <br /> 6. > t+f <br /> 7. <br /> I declare that tis'aPP (including arty aecompaaYleg schedule)has been examined by me and to the best Of Orr <br /> knowledge and belief a is true.correct and complete. I adowadMNe Mat I am respohmible for Uha detail and axumcY d all n m y m we.: a <br /> bdormeam mrltalrhld b finis applkatbrr(induding any aemmpanying schedule)and I ft~dadare that I recognize that the e c S y <br /> the Courts of Bumex Wisconsin in determini g whether to'sm a pwndL I <br /> kramatioa I am Providing wdi be relied upon by I am Providing in the ^ �° N " r <br /> further accept ON NaAMW that may be a rm t of the Countr of Burnett reYing on this krforrnallon <br /> munty ordinames or atlher auyhorited person m a" <br /> haw access the obovaree tD�desnibed Premises m y reasonable them NOWis charged with �tlhe purpose of iropection. <br /> .2.- ii '1^ ya� tan m31O <br /> OWNER'S SIGNATURE A <br /> (dam) n —Z <br /> /��� o Rr,� <br /> I(Yl LU i i CCt.n 9 ;.q. <br /> s n Lr1 <br /> ZONING ADMINISTRATOR X <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE »$� <br /> 'f31 —( I ufw3���8 <br />