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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER y I )AVtA TELEPHONE <br /> b `Z�735- 7872 d Q <br /> L � w <br /> MAILING ADDRESS <br /> .4733 PC( (� ((�� <br /> IL- LOYT11rllAW) IJR �{lZ 6r LaLko PtA_ I Mn( <br /> ° <br /> �SzEC o� <br /> PROPERTY ADDRESS ''j^ �_ <br /> 2g�`l3 l (e�sl.lY'� TSlar,.d L►tcl �,tDL-. �c��l�sI' � o � <br /> LEGAL DESCRIPTION "� o <br /> �C)�- 5253 1rO0WV rt T> ,t. a Rddl <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK ❑ <2!!LGWACCEStOr&STRUCTURE la' <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> a <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: Ciar �U1 0 <br /> (Home/Cabin; CoYnmercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: C LI C_ n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 r/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tnn O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. f1 <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, CT{ v <br /> AND INDICATE NORTH (N). Zj N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o <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. RJ d U <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES i <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. rn <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 U) <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. "4�� J" <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (J'( y <br /> NEEDED. I \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. U <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER %rl <br /> SETBACK AREA. O V <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. Q <br /> 6. <br /> 7. '^ qy Y 'og c] o cv a C7 tC <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this ,e s m <br /> N ; y <br /> information I am provlding will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit I .� is A a ? io <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 A n c 8 $ $ rrr <br /> access to the above-described p ises at any reasonable time for the pure of Inspection. m w c o'A c c o > <br /> a <br /> � o y <br /> OWNER'S SIGNATURE <br /> ash z <br /> bias <br /> ZONING ADMINISTRATOR �9 <br /> JUL to j ZUiz <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS&C NETT COUN ti o N o <br /> ZONING <br />