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GEL 1716 550 2__ <br /> Burnett.County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y <br /> 5 <br /> OWNER TELEPHONE °' <br /> MAILING ADDRESS <br /> 2 i22. LAY=G AQkF -DRIJC?>C Y <br /> PROPERTY ADDRESS 5 V' <br /> errs 1 <br /> 2Z Akt A. 1� tkIL) Pl kyf suf33n (i91 <br /> `• S <br /> LEGAL DESCRIPTION <br /> 0 <br /> TYPE OF PERMIT(s): SINGLE-FAMILY DWELLINGS ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ G� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ T <br /> J � o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: I^I O►{L z ,o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) -� <br /> BUILDING CONTRACTOR: _ ©t��t7Fz@. c OJ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS _ o 7 <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. C l7 A <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, l <br /> AND INDICATE NORTH (N). = Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) 5 <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. O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES y' 09 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N I <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 WHEN y O O <br /> NEEDED. � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C� <br /> c <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. z Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C7 <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. <br /> n 'Jy Dr� � � OD O <br /> rt R K a l <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my e y 3 3 3 o w <br /> 3 Z <br /> knowledge and belief k Is true,correct and complete. 1 acknowledge that I am responsible for the detail and acture '2 <br /> of all <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this ° <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I d _'i <br /> t �- ao <br /> further accept all Ilthat may a result of of the County of Burnett relying on this Information I am providing In this c�' <br /> application. I agreee to to p permit co ty ty o leis cTed with administrating county ordinances or other authorized person to have <br /> access to the above-describe re i a an asonable time far[he purpose of Inspection. <br /> a D � goo � <br /> OWNER'S SIGNATUR c o,W <br /> C (date) o a a; I Re <br /> 1 = <br /> I^ �+�; <br /> ZONING ADMINISTRATOR \ �� I�I I ( �)(,( (� � = n <br /> TOWNSHIP PERMITS MAY BE REQUIRED w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v =N <br />