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rn ro z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator < <br /> APPLICATION FOR LAND USE PERMITS a a <br /> OWNER c an ,J sw0� TELEPHONE <br /> J ,� d <br /> LU i IXC (f� Jc ([ / J /��/ <br /> MAILING ADDRESS (7 2 14 '�Q_,�q A Ave rnye C6- Ove 1 1 T J m N 69 L <br /> I J CJ Cwt J <br /> PROPERTY ADDRESS aS 4 ,3 T6h n.sor) / � i�_ z , C� Q <br /> LEGAL DESCRIPTION ° <br /> Lr <br /> y <br /> TYPE of PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ 4- <br /> _ <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 Val- ' 1"` <br /> STRUCTURE/ADDIRON USE: aict1 i-1 Dn W l( l, kaoe a lbedyooen.S +Z)]Lc�' I 5 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) W <br /> BUILDING CONTRACTOR: p ,� <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 N <br /> WILL BE RETURNED. a <br /> L'1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. S: <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, J a <br /> AND INDICATE NORTH(N). p c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) <br /> p w <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK � � � Q <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 o 5. <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. ) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d` c <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <� J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 32 O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. m Z p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O y <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 0 0 \ <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMANHA ITATION. <br /> 6. f)s paCundr�ons �Var1ance. 4t99,�2 <br /> 7. � po > o 0o C) aO '0 <br /> m N a E m <br /> Fn m3 � 3c =. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 i <br /> 0 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all p, <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this ° =.> > m <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I w ? L '= Y <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this 'yo q N "V <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to m C) m <br /> P y purpose of inspection. > �o w N w n <br /> have access to the above-described remises at an reasonable for the u <br /> OWNER'S SIGNATURE)SY�CC.,OI�Y\ C A ) 4_.1 O�.i' 3 A �' o g g o > <br /> vy (date) <br /> ZONING ADMINISTRATOR :Tiff) Rar iqnq� 5 <br /> $ F� <br /> _ <br /> p's1 <br /> C21 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o . <br /> (mi+ le+lei Pie.K� �tiP bv�SCimeS�Shce�an Seidl <br /> 0 0 0 0 0 <br />