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Burnett County 7410 County 62 K, No. 102, Siren, WI 54872 9Whaof toning Adpiinistrator n Z <br /> APPLICATION Fact LAND-ISE PERMITS € ° <br /> ffl-3 S- S g`h� <br /> OWNER �C rY ^ TELEPHONES <br /> l Yl I t <br /> MAILING ADDRESS If <br /> \ e, <br /> PROPERTY ADDRESS /l5 n c f� <br /> Kms 2� � t� <br /> LEGAL DESCRIPTION O <br /> J <br /> < N <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE 0 ADDFF"R 0 STAIRS 0 <br /> TYPE OF DERM(T(5): _ <br /> FILLING/GRADING 0 CAM <br /> 'f G UNIT 0 BUNKHOUS(X 59.692(1V)GAZEBO 0 DECK O <br /> STRUCTURE/ADDITION USE: ( u /]_''.t��� e� LL <br /> Hom in; Cpmmercial o'siiness; Bedroom; Deck;-etc.) Rr o G� <br /> BUILDING CONTRACTOR:_ 'AV//t Q -e Rf "e5ioI I <br /> A PLOT PLAN MUST 86FROVIDED ON AN 8 <br /> WILL BE RETURNED. Y HELI OF PAPER. ANY IEGIBLE PLOT PLANS <br /> INCOMPLETE OR IRw W <br /> O ; <br /> QIRECrIONS FOR PLOT PLAN DRAWING: OP VIEW) C z c <br /> o <br /> 3• ALL REQUIRED DIMENSIONS ORD TO BE SHOWN OR DRAWN TO SCALE. Q <br /> - SHOW THE LOCATION AND SIZE OF ISTING BUILDINGS/STRUCTURES(ES)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCL G DECKS, PORCHES AND OTHER STRUCTURES, c z <br /> AND INDICATE NORTH(N). w <br /> 3. SHOW DIMENSIONS IN FEET OF T G: (A) BUILDING(S)TO ALL LOT LINES, (8) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C)BUI REMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHW M) OF LAKE,STREAM OR RIVE NO AREAS,AND(D)LOT DIMENSIONS. n C <br /> (10 <br /> rw <br /> 4. SHOW THE LOCATION OF THE WELL(t DTIC TANK(ST)AND DRAIN '(OFj,AAD ALL DISTANCES cEIEE9 <br /> TO BUILDINGS,ROADS, LAKE, LOT LI g <br /> S. INDICATE IF A WALKOUT BASEME 0 BE <br /> 6. taRAQEQ OR FILLED. <br /> AND D IF SEPARATE PLANS ARE IYy1M40%WAOM ITC.,TI <br /> PLANS MUST BE SIGNED AND DA QW !�- <br /> NOTE: BUILDING/STRUCTURE LOCATIONS STAKED SO AN ONSITE VERIFIGATW"01ft"O" 4 � <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN <br /> DAYS OF PERMIT. L' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATIIIyd6 RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELANO ALTERATIONS ARE AkiOWED UNLESS'SPECIEICALLY DERMITTFD. R \ <br /> 4. NO STRUCTURES,INCLUDING RETAININ WALZS'ETC.,ALLOWED WITHIN THE REQUIRED WATER I 8 <br /> SETBACK AREA. My, <br /> S. ACCESSORY SED FOR HUMAN HA PERM ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Jt`•J <br /> NOT TO BE USED FOR HUMAN HABITA E <br /> 6. <br /> 7. 7e >n�F> <br /> - Q.14 <br /> n 3 a ` F <br /> R- E,a,1` �. <br /> I dedarc Mat this apDlicaborT 1!11 11:11':1 any xcompa ing schedule has been e:a 1 W <br /> mlba4aly me and to the best of my knowledge <br /> and ' <br /> belief K Is true,correct and complete. I acknowle.�ige MATTI responsible for tha4vW and accuracy of all information con <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this informatlon I- E F,- > <br /> am providing will be relied upon by the County of Bumett Wisconsin In determining whether to Issue a permit I further accept all <br /> liability that may be a result of the County of Burnell nalying on this Information I am providing In this application. I agree to <br /> permit county officials charged win administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any res ble time Por purpose of inspection. <br /> : sa3i <br /> OWNER'S SIGNATURE • lC.C1A4 ,V' n - <br /> InS " ' s <br /> ZONING ADMINISTRATOR i m ll,C�( � (date) r" . fq <br /> TOWNSMIP PERMITS MAY BE REQUIREIr.. <br /> THIS PERMIT SHAJyr EXPIRE ONE YEAR FROrDA F ISS,{ FCE €M M <br /> ��/h��•I'o< IPf�'G'd�c( �?,c{—lam I�t�I�Ct.�2Pn-�c� ��� <br />