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� � z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a i\ <br /> APPLICATION FOR LAND USE PERMITS H W <br /> 6 Q <br /> OWNER I . I� TELEPHONE Ac�_ ���� <br /> w <br /> MAILING ADDRESS 3 <br /> PROPERTY ADDRESS G <br /> ZJJ l// J c./�j <br /> � C1I 5�G OO, an Ce d i1/tDlj /ah' wl tl�" 93 c <br /> LEGAL DESCRIPTION <br /> a<1 Ccu1` jet 4SPctroh g-`l�-ly �urNetl f <br /> 1 TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK C3GARAGE/ACCESSORY STRUCTUR v, <br /> I o <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COnMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c � <br /> STRUCTURE/ADDITION USE: r C Ie U;lei biQ � to <br /> (Home/Cabin; Commercial Business; edroom; Deck; etc.) <br /> BU ILIING CONTRACTOR: k66,5 CC)lis t/Licf/Oki ct•'k ROCT%a4 CA <br /> n <br /> XXs-kll9-Oly� G��3/� CHw.0 PLOT o � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETEOR ILLEGIBLE PLANS C 0 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tri <br /> }— c <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 t"•f w `% 9 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <br /> AND INDICATE NORTH (N). tv z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) 0 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK o <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 5. t <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <::) <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 ...I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <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. 'A <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 ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. a > o 0 0 c ro <br /> rnn R333 � g � � <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my 3 p' ;° 9 <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ally m' a. <br /> F <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this Y <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <br /> w <br /> further accept all liability that may be a result of the County of Burnett relying on this information[am providing In this <br /> application. I agree to permit county officials charged with administratingi Dynty ordinances or other authorized person to <br /> have access to the above-descrl dp I s a reasonable time forlhe purpose of Inspection. 8 o w"4u (� <br /> i 7�' . c `ngoY <br /> OWNER'S SIGNATURE <br /> A 6 ° <br /> acon � � _. z <br /> ZONING ADMINISTRATOR APR 222010 <br /> ) M <br /> n <br /> w ff] <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEZONING <br /> Yf�r N69 bi�� <br /> J N O Vi O <br /> t A t A O O O O O <br />