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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS2. <br /> - <br /> OWNER I{aESCUFJL/ TELEPHONE <br /> D O <br /> MAILING ADDRESS 12-98 r-APrl( &At C{.'EC » <br /> A(2g,- 14w nya /iL ft <br /> PROPERTY ADDRESS t 'r1 ' <br /> LEGAL DESCRIPTION _ <br /> TYPE OF PERMITL6): SINGLE-FAMILY DWELLING ADDITION DECK GARAGE/ACCESSORY STRUCTURED <br /> BUNKHOUSE 0 S9.692(IV)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT — r r <br /> j <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: _( Ceb,b;I h; IYI am; <br /> Dec/. <br /> E 1rC14 ///Gobi ; Co merclal Burnes , Bedroo-m, Decksetc.) <br /> BUILDING CONTRACTOR: l <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <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 <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, I[� ` <br /> AND INDICATE NORTH (N). y.J r <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(5)TO THE ORDINARY HIGH WATER MARK 'TTTT� 1 <br /> (OHWM) OF IAKE, 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 <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i —C_ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE n ' 36 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I %Z ��n• <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN p <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> rUyt O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED <br /> UNLESS ALONG SHORELINE. F <br /> 3. NO GRADING OR SHCLUDING ALTERATIONS ARE ALLOWED OWED 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 ONLY. <br /> NOT TO BE USEDEDFORFOR HUMAN HABITATION. <br /> J. & 'z >n n n n> cT <br /> ^ 3n �o <br /> 1 declare that MIs appIt Is true, <br /> (Inducing any accompanying schedule)t as been examined of r t and to Me best of my <br /> knowledge and belie)It Is true,correct and complete. 1 admaw parrying <br /> that I am responsible for ed m that <br /> and a ombe of all p= @ o <br /> Information contained In MIs appdwtlon(Induding any ac ponying schedule)and 1 further declare Mat 1 remgnlae permit. <br /> this <br /> Information I am providing will be relied upon by Me Cou of Burnett Wisconsin In Oetertnlning whether M Issue a permit t 3 `pN — <br /> further aocept all Ilablllty that may be a result of Me Con of Burnett relying on this Information I am providing In this —_ r5 u'�' <br /> apphi:aoon. I agree to permH munty o lals charged admlNrtradng county ardlnan¢s or other adhorized person to have ,� <br /> access to Me above-desaleed premis at any reaso a 1 time for the purpose of Inspection. _ j g rvn <br /> "//J � mjQ�Bcgo � <br /> OWNER'S SIGNATURE <br /> r a Eo % <br /> ZONING ADMINISTRATOR_ - w n BOW <br /> c: € M <br /> TOWNSHIP PERMITS MAY BE REQUIRED JUN g 3 1014 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE CUANCE �' <br /> u N�000� <br /> BURNETT COUNTY <br /> ZONING <br />