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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERTELEPHONE O <br /> We,6jfer School DIs Loc-" lir drG(o~ y3q l <br /> MAILING ADDRESS �,/�p ) _ r/. /� „/ /i✓P ('du " 1 ^ <br /> PROPERTY ADDRESS /aV/U t /4 O/3615 SSC��/ <br /> c r <br /> LEGAL DESCRIPTION CeC yf� /774) /u� <br /> TYPE OFPERMrr(S): SINGLE-FAMILY DWELLING O ADDITION O DECK O GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE O 59.692(1V)GAZEBO D STAIRS O FILLING/GRADING O CAMPING UNIT O <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE O r <br /> 'o <br /> ,y 0 <br /> STRUCTURE/ADDITION USE: Sh e./ Gt S600/ ('P,S / Y <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: jhvio cauh—t4ateileel's n <br /> y r ^ <br /> O v) <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> 6 <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. n <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, p <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <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. C7 DO <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES r <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. QJ L/J <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 6' W <br /> NEEDED. <br /> v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: U <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _I <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 <br /> SETBACK AREA. Sy <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. T o 0 c <br /> is ov <br /> o n R339n ? m ,� <br /> H 333 g3. , <br /> � Z $ A A <br /> [declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 e ,� � R qa <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 o E, aN <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I y a b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c � s, ,�, b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized Person to have '" o $. S S 1 <br /> access to the above-described premises at reasonable time for the purpose of Inspection. m w f� <br /> j aSoo8Sy <br /> OWNER'S SIGNAr »'. <br /> (date) o a> ? R 9. =. Z <br /> ffnn— H T9.y a 3 s7 <br /> ZONING ADMINISTRATO B <br /> o <br /> TOWNSHIP PERMITS MAY BE REQUIRED Q °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �� SaooS <br /> pe r' l + 4 to+kor (nal tm fD�- ob( ��cf <br />