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C A p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS i5c <br /> _ J <br /> OWNER C TELEPHONE - 'X <br /> T 0i a5a9 <br /> cJo[_ Lr oc /LYtcl43/- RAO -7si5 < <br /> MAILING ADDRESS /`'�l(2 <br /> /�/ <br /> PROPERTY ADDRESS ' ��t? Y�-�, O� <br /> L7516- KibVal i � _� <br /> LEGAL DESCRIPTION f O v L_O� <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING)k ADDITION ❑ DECK O GARAGE/ACCESSORY STRUCTURE ❑ 6 <br /> BUNKHOUSE O 59.692(iV)GAZEBO [3 STAIRS O FILLING/GRADING ❑ CAMPING UNIT O <br /> 0 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> I/ <br /> STRUCTURE/ADDITION USE: of"I o@ <br /> (Home/Cabin; Comme ial Busine ; Bedroom; Dedc; etc.) <br /> BUILDING CONTRACTOR: 0/1� !2 ee' JQJ <br /> «< n <br /> � G1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O o J <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AR)AL OR TOP VIEW) ICx' 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 <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) BUILDING(S) <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 tv9jTO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> y <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 o -� <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: w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 3 <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 _' I� G <br /> SETBACK AREA. (�l <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. ; p o o a> `tl <br /> X a Ie1 <br /> �.�. <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief R Is true,correct and complete. I acknowledge tlrot I am napornible far the detall and accuracy of all <br /> information contained In this application(Including any accompanying sheduk)and I further declare that Irecogntze that le <br /> m <br /> information I am providing wla be relied upon by the County of Burnett Wisconsin In determining whether to Isue as per mIL I <br /> g e R m cye <br /> further accept all tkblllty that may be a remit of the County of Burnett relying an this Information I am provWeg In this <br /> application. I agree to permit county officals da in <br /> admNtrathg county ordinances or other audwrized person to <br /> have access to the above-described prem rt time for the purpose of Inspection. >y <br /> OWNERS SIGNATU a l $8 o <br /> ZONING ADMINISTRATOR �J' 6Ln t Qh Gil J J g H z <br /> y w _ !+1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED a ' <br /> r : w <br /> T`HIIS PERMIT SHA4 EXPIRE ONE YfAR FROM DATE OF ISSUANCE <br />