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�NoI 6 t a� ����,;s cl'aa V'2,S <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administra or e In o <br /> APPLICATION FOR LAND USE PERMITS <br /> 6 <br /> OWNER TELE HONE <br /> v� V Ytole <br /> d <br /> MAILING ADDRESS S1C Y\ <br /> o <br /> A <br /> PROPERTY ADDRESS v I ac) <br /> L) O <br /> LEGAL DESCRIPTION _ 0. �' 1 <br /> SINGLE FAMILY DWELLING E3`-GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIR ❑ g <br /> TYPE OF PERMIT(S): 'e <br /> FILLING/GRAD(/ING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK -p <br /> STRUCTURE/ADDITION USE: `sUNZA&6 2+'f-? N ACC <br /> (HomCabin; Commercial Business; Bedroom; Deck; etc.) 2 <br /> t <br /> BUILDING CONTRACTOR: (- �) �C--' <br /> W � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT Pt ANS C ry <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 C :: <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) BUILDIN (S) ' 3 <br /> 2. <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ') a <br /> 4 SOH WMT HE OFLAKE, STREAM LOCATION OF THOR RIVER E WELL(W),DSEPTIC�ND AREAS, DTANK(ST)AND (DF), AND ALL DISTA CES a N J <br /> 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,I HE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. OQ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE Wir EN <br /> NEEDED. G (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' -5 <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 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE CNLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. VA- > o -0 <br /> 7. <br /> I dedare that this application(including any accompanying schedule)has been examined by me and to the best of my knowle ge <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ,� o <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further amer t all Q ,�,,o N`�8 b <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above <br /> 7deesscribed Premises at any reasonable time for th(ee purpose of Inspection. <br /> � <br /> YJ VY� 1 ��y�n }`QYf CIecS� l N � � 0 <br /> OWNER'S SIGNATURE l� _ o A i.,y �' d 7' <br /> > a <br /> ZONING ADMINISTRATOR Flo ( 0,n <br /> TOWNSHIP PERMITS MAY BE REQUIRED ^' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O� 8 <br /> PP�m( � q- le,- W (-added +r, jeFilerce, 6-At- <br />