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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 9 <br /> APPLICATION FOR LAND USE PERMITS <br /> _ <br /> OWNER M\G�rxe( 4.n /I 1� LQC���2 TELEPHONE o <br /> �I <br /> MAILING ADDRESS cX C�Gl V <br /> PROPERTY ADDRESS 9 <br /> LEGAL DESCRIPTION Jac <br /> l <br /> TYPE OF PERMTf(5): SINGLE-FAMILY DWELLING❑ ADDITION t3 DECK ElGARAGE/ACCESSORY STRUCTURE ❑ H (� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c - <br /> STRUCTURE/ADDITION USE: YY\�Cl(L- t, (2 r <br /> (H Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> P <br /> BUILDING CONTRACTOR: Lz� C�2 S'3 t^Rti �.o^$kYW C,A-LA's — S coo✓��-1 r <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANSC o <br /> WILL BE RETURNED. � — — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n °' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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, e <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES n <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. pQ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. l <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHENfi 3 <br /> NEEDED. <br /> n OI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> G y� 0o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 1 O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ti z O <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. ^ 0annnc, aov <br /> " n C 3 3 3 A <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 9 e <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m d=a ! y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this °. DD m 'O <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d &.a ,w= Y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c " ;,,;,,.<-�•N •% <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable tFne for the purpose of Inspection. g a $ 8 <br /> > <br /> OWNER'S SIGNATUR ( ( Z l 6`1 w j o 0 0 o g <br /> m a L' <br /> (date) <br /> a V' a". mn h � O <br /> =9gg <br /> . z <br /> ZONING ADMINISTRATOR �'m 1001��� ' <br /> TOWNSHIP PERMITS MAY BE REQUIREDni <br /> O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE la H N H H»^ <br /> P��m��- d lea's pir✓k-e�' �� iT1 (eG�.e� �echn�r ii'a-69 � � g000g <br />