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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 z <br /> APPLICATION FOR LAND USE PERMITSr X y <br /> OWNER p TELEPHONE��,� <br /> b 4 �f Y11M'Ir �� rEte�c 1crJ G (641- 40- 1339 <br /> MAILING ADDRESS <br /> 1V 1 �l t <br /> PROPERTY ADDRESS rl �] 17 <br /> CJ1 / 0 1 <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY <br /> �STRUCTURED <br /> C' <br /> STRUCTURE/ADDITION USE: t4 , /� have- &/�/Uofn S 1b1Z0 <br /> 0 <br /> (H me/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> i <br /> BUILDING CONTRACTOR: .'1 ti GV <br /> �1�RJ �� Q7t' �1 Cil l a O 3l/OGV <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 <br /> WILL BE RETURNED. C 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <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 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, El <br /> AND INDICATE NORTH (N). N J c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 1 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. — I <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. U.I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 90 <br /> p <br /> V1. 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 <br /> v.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 /> A 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. Bf �.1 310 aa mv <br /> no n 3 <br /> PP (Including Y accompanying ) y y "FZo � AAS'o'� <br /> I declare that this application indudin an aaom an In schedule has been examined b me and to Me best of m <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m u m v a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this a E. > a m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I Y <br /> n — <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have w,°� o o ssssssoxxxxxx o ,r_, <br /> access to the above-described premises at any re nable time for the purpose of Inspection. <br /> Y <br /> OWNER'S SIGNATURE X —/ ,�-ya E o 00 0 o y <br /> .f A G d <br /> 69 9 <br /> (date) o z <br /> ZONING ADMINISTRATOR �/_ I FIC I 1yl(�Yf I 'Z V e y °e X <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O <br /> � � 00000 <br />