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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator y <br /> APPLICATION FOR LAND USE PERMITS g <br /> /i / z <br /> OWNER—____„� li Yom/ h v' <br /> TELEPHONE <br /> r S looS� <br /> MAILING ADDRESS <br /> '7 <br /> PROPERTY ADDRESS <br /> o 5' <br /> LEGAL DESCRIPTION <br /> I� y <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ ° 5 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BBU'N^KHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ I <br /> STRUCTURE/ADDITION USE: hama —mil-// alyac4A7LD `j� /�Q �aA <br /> (Home bin; Commercial Business; Bedroom; Deck; et . Z � c o Q <br /> BUILDING CONTRACTOR: 5c_1L A ` p <br /> i w rte\ tea, <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. y.�� 1n /'�r� v) r� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, "I <br /> 4. SHOW THE LOCATION OFITMEASUREMENT OR RIVER AND <br /> HE WELL(W)SEPTIC TANK AND DRAINFIELD(DF),AND ALL DISTANCES r F ' o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> ° W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 9 <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. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HA ATION <br /> 6. &p�ci vF }Nu s- 7AT ION rc +o be c l asci Ehar,'75 fctt I o <br /> 7 DYdlntt/y hioJh 044e-rC)'1CL/�. � ^f anwF�y <br /> 4o berc�loceGti! No (o 'and a heWw Un�t15�7.fo9a Llv� ara�ely F � "2. F�g <br /> I declare that MIs applkatlon(Intludinq any accompanying schedule)has been ezamined by me and to the best of my knowledge <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for Me detail and acaraq of all Information <br /> contained In this application(including any accompanying schedule)and I further declare that[remgnra that this Information I ' <br /> am Providing that will be railed upon by the County r Bumex Wisconsin In determining whether to haws a PermiL I further accept all c E«=' <br /> liability that may baa chart of the County administrating <br /> Burnett relying an Mts Information I am Providing In this application. I agree to ,"'nPermit county premises <br /> t any <br /> reasgedonable <br /> with a time tratlnq county Irons or other authorized person to haw amass to Me above- S q <br /> described premises at any reasonable time rpo f inspection. a„a <br /> a <br /> co <br /> SIGN HERE ^ <br /> (signature of owner or b Ing contractor) o e u S. 7 <br /> I ^^ date <br /> ZONING ADMINISTRATOR � FI,a�(•vlQh ) ? H $ gw <br /> C ` P <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE p <br /> n O N J O <br /> P"mi,4- 124-1e- lD Edward Crb g -/3-64 <br />