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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS r <br /> OWNER V�� N I/)/' ' ` �I\ TELEPHONEcell -71S 737 O/ / <br /> / J fo! � Ll <br /> MAILING ADDRESS2 p <br /> O�i7�`t (.ov(c /2e IC o/ij ( j/P �, �j �.� 14p- <br /> PROPERTY <br /> (ePROPERTY ADDRESS 3600 7/301V <br /> LEGAL DESCRIPTION /,OV� �Of�Y 0 —1 Ga$/ W 71)J/4 AC/ <br /> TYPE OF PERMITS): SINGLE-FAMILY DWELLINGX ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 (� <br /> BUNKHOUSE 0 59.692(IV)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: /I�M e� t <br /> (Home/Caton;Commemal Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> n n <br /> AP LOT PLAN MUST BE PROVIDED ON AN 8'/a X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. u _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 2- <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 u <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J <br /> AND INDICATE NORTH(N). I Se <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) = � � :5z <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(1V),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES - p <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. F. (� <br /> S. INDICATE IF A WALKOUT BASEMENT 15 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE N I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. L?) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> v O_ <br /> L DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <br /> 2. REMOVAL OR CURING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = z <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 I <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HASARO . <br /> 6. Hll raaIvI:L-/ Wef�a�/ gn /a1' lihc 4e bd,ckf /+'lust be. k" <br /> T. do consfru�{ah sryoll sfwrf un7a Sw i�r vy Poe-e."/ /s /slue l <br /> 3 3 <br /> kamaleeteand belief it isttrueon,correct andcncluding any accoeti,. Ickowledng e)M1at I en amezaminetlbyr the detail <br /> athe iland ft Of accuracy <br /> o.2 ,el ,rtla <br /> knowletlge and belief it is true,correct and complNe. 1 acknowledge that[am responsible Fur[M1e tletail and aauraq of all <br /> informaBon contained in this applicahon(including any accompanying schedule)and l Further declare that I recognize that this -- > e <br /> information l am previdin lite relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. l s+c �� ' <br /> Further accept all liabilitytha ybearesultofth of Burnett relying on this information I am providing in this m' — Lu <br /> application. lagreetoperrmitt oa�Y olficiili arg w, Eministsati manly ordinances or other authorized person to <br /> have access to Me above�\tles/cached premizei - any le time/ the purpose of Inspection. o T'1 <br /> OWNER'S SIGNATURE K.1 II / 7, 30 - 14 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED = _ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ <br /> uu8 = e o = <br /> 1 <br />