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e T Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS H F J <br /> OWNER TELEPHONE N&�F w_;'-483-1083A <br /> _;'-483-1083 ° a <br /> � DOLPH C, MOMA45�1J ZA-K,I:I gx's-74 (9 ° w <br /> MAILING ADDRESS PLo 00 )( b Z4_ S bg/X F^ Is, GV�e �ADz� VJ <br /> o C <br /> PROPERTY ADDRESS <br /> J 7gOZ MAILAkP L,4Kt KP.. <br /> G � <br /> LEGAL DESCRIPTION e.r ter^ /r� <br /> TYPE OF PERMIT($: SINGLE-FAMILY DWELLING ❑/ A7DDITIION 0 DECK D( GARAGE/ACCESSORY STRUCTURE ❑ 0'` <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> rt <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ❑ COMMERCIAL ACCESSORY STRUCTURE Doc <br /> STRUCTURE/ADDITION USE: X C K D rx /l/o'1'�C _ o <br /> (Home/Cabin; Commercial Busines ; B droom; D k; etc.) <br /> BUILDING CONTRACTOR: J n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) d p <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 rM <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Z <br /> AND INDICATE NORTH (N). c C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK J �, <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. t7 <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. w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE ,lv (� 4 4- <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. (Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: G c� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r) <br /> P <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. !n UQ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ci <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER L1 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FO6. Tf1 S p4!/ri� i.5R.SSU2d fOHUMAN lreplure eALSf7;,P leG,tS 0/,Il-, I)Ykb'lake SlAt4*'X12 back E <br /> 7. m o 0 0 L) a troyl <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my = e? w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all rd m m a; H <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .� 9.9 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I m 5 A ?w V <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have n S 8 <br /> access to the above-described premises at any reasonable time <br /> for <br /> /1the purpose of Inspection. 'N c I > <br /> OWNER'S SIGNATURE (date) <br /> ZONING ADMINISTRATOR <br /> C <br /> TOWNSHIP PERMITS MAY BE REQUIRED C <br /> qQ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a N H <br /> '7 � -1- d- t4_1- kr � �c �(t0�phrY1G'/17rnSCn /0 "Cy � aoo�o0 <br />