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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE c <br /> �flzoiie a nar30cr 6ix- b3�99y315 <br /> MAILING ADDRESS y/6/ kn.O1b ar Ca,A/t1 'M/f/ ;5XIkZ k <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION Y3 p��p J !3 c <br /> TYPE OF PERMIT($): SINGLE-FAMILY DWELLING U DRON ACK AOCK GARAGE/ACCESSORY STRUCTURE K L51 <br /> COMMERCIAL <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 ") <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE ❑ '- <br /> STRUCTURE/ADDITION USE: ST/w ILG.O R/� L��/y/� <br /> (Home/Cabin; Commerciar Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Ay S It1IK,F^(^� <br /> C <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANSz I <br /> WILL BE RETURNED. ,C*„ ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ori — ) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. U _ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 SU <br /> AND INDICATE NORTH (N). cI <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUIIDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK nR <br /> (OHWM)OF IAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. G <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF), AND ALL DISTANCES q <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES, <br /> S. 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. <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: � I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, n .z b <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. EN, z Ul <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L C) <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. E <br /> 6. Si Jf%rr i To TjE Vo' /n/N. FRoM WtT/"Z, <br /> 7 sg; > nnnp> O • <br /> " � GoFt <br /> Z 33 � m <br /> I dedam wledc Mar Mls appt s true, <br /> ,comeing any accompanying I ng scfmdule)hes been ezaminad by meof r t and to l and ac ur my <br /> Imowledge and hNler tt Is true,corrttt and complete. 1 aclm panni a Mat I am responsurt further <br /> Me declare <br /> and cognbe of all <br /> Information I am pied di g apolmtled(inclupon by t any accoCounty <br /> of Burnett <br /> schedule)and.1 t r min ng whether <br /> 1 issue a e Mat this <br /> Further ac n I am pmvlity t will a relied upon by Me County of Bumett Wiscorelying <br /> on In EInfori determiningIam to issue a permtt. I _ <br /> Further accept all liability that may be o resW[ch Me County of Burnett relying ty this antes r o I r pre razed In this Q 'aa ';�v` 8 <br /> application. 1 agree to penntt county olBrials rilargM with adminl4ratlng County ONInanCeS or other authorized person to have ^ m J $$ : $ o li <br /> access to Me above-desalted premises at any reasonable time for Me pu ° n a g c o S o <br /> OWNER'S SIGNATOR � �� J�1 L7 '6n— <br /> ZONING ADMINISTRATOR _ .JUV3 0 Z014- <br /> Li U <br /> TOWNSHIP PERMITS MAY BE REGURNE�T1Te COUNTY'nO <br /> aw <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE ZOOS r{atNCE a N a <br />