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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 v <br /> � e <br /> �OWNER TELEPHONE G <br /> Y=��4 o Qe_2t� 507- ' X- (a7,`l <br /> MAILING ADDRESS ., <br /> 'T O la C% <br /> ^ r� n n ((�� ��1 ��I ��'TTT p . <br /> PROPERTY ADDRESS <br /> dO yy R.� IJah b,, Y_ cr- r` 03 o t <br /> LEGAL DESCRIPTION <br /> PCC GOY. /'ET H Ty or <br /> TYPE OF PERMIT(6): SINGLE-FAMILY DWELLIN ❑ ADDITION ❑ ECK GARAGE/ACCESSORY STRUCTURE 13 <br /> BUNKHOUSE ❑ 59.692TV)GAZEB0 ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ .5 <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITIONn❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabm; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 0 L✓Y) C v- r, <br /> s I ` <br /> A PLOT PUN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PUN DRAWING: (ARIAL OR TOP NEW) <br /> I. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. _ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW - f' <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, R <br /> AND INDICATE NORTH (N). o Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDINGS) -I <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 H O <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND(D)LOT DIMENSIONS. J <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF), AND ALL DISTANCES = p <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I P <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 /> t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: g O 1y'A <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. �; •I <br /> 2. REMOVAL OR CURING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. A tY <br /> 3. NO GRADING OR SHOREUND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, t <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 8 <br /> SETBACK AREA. N �( <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Q <br /> NOT TO BE USED FOR HUMAN HABITATION. S <br /> 6. 4 N Y ADDrr/KA) jot DELK die ,PocF 1,&ST Sr.OZ 1BaaDE Id'SCTftc M 42e7N6RnJ <br /> 7 VA* P/BTY <br /> I decia a Mat this application(including any ao,ampanying straddle)has been examined by me and to Me[lest pf my <br /> Imowledge and send R is Wq content and comVlave. I aclmowiedge that 1 am responslbk for Me detail and ac c,of all be. <br /> IMormatem[anima,N this appgradon(including any accompanying schedule) hat <br /> her and 1 Nrer Modem Mat 1 recognizeMIs Mat E.> > to a Y <br /> IWorth thm 1 am proNding will be rclled upon by Me County of Bumett WoKondn In deterrrming whether m lave a Permit. I ?R — <br /> NrMer a=pt all liability Mat may be a malt of Me County of Burnett raying on this information I am providing In this <br /> ayplkabon. I agree to permit county oMdals charged!with adminiat adng county ordinances or other authodzed person to have D I o o v r <br /> aaes to Me above-desalDMprerll.Man reasonabl.time for Me purpose of Insyedlon. v w a?W$$n <br /> OWNER'S SIGNATURE <br /> ZONING ADMINISTRATOR—J 1;7 T.m <br /> —J BYtlI l/ L5 b - <br /> TOWNSHIP PERMITS MAY BE REQUIR D °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DA I 8 <br /> APR 2 b 2014 <br /> BURNETT OOUNTy <br /> ZONING <br />