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o <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITSCAJ <br /> y <br /> o <br /> OWNER (�L } GAIL CTELEPHONE 763-767" 303 <br /> I i V t.-SS .3 <br /> a L <br /> MAILING ADDRESS /95D(o //'YU,$/j JT AJC ` A1VC0V6--I 1111 ../..-t>CT � <br /> i <br /> PROPERTY ADDRESS 2g467 a-3_1�60,-i Gf4r <br /> / \ c <br /> LEGAL DESCRIPTION LTJ t- h/v o <br /> TYPE OF PERMMS): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ rt <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FIILiNG/GRADING ❑ CAMPING UNIT ❑ <br /> v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ .°r. <br /> STRUCTURE/ADDITION USE: YU� - zm e31 <br /> (Home/Cabi merdal Business; Bedroom; Deck; etc.) �O C 'Qj <br /> BUILDING CONTRACTOR: (J� <br /> n � <br /> " � J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ 0) <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r) <br /> 1. <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, b <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) °o �1 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �' O <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. g <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF), AND ALL DISTANCES 3 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. S v, <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. H <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE ?111) o ( � <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. r <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. (� <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. � na � <br /> 9 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 9 0 q R B $ <br /> knowledge and belief R is true,correct and complete. I admowledge that I am responsible for the detail and accuracy of all g, to e.P_ E <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permlt. I $ 5 w a w V �0 <br /> further accept all liability that may be a result d the County drn <br /> Burnett relying on Mdorrr <br /> Is Irutlon I am providing in this Cr n 8 i„N c <br /> application. I agree to permit county oMdals charged with administrating county ordinances or other authorized person to have .� 0 8: 8 <br /> axes to the above-desoibedIces at any reasonable time far Me purpose d Inspection. m 5 2 A w ti w 9 <br /> p a 8 8 g > <br /> OWNER'S SIGNATURE ,� Le-H-10 R <br /> (date) n y a o m C 'Z' <br /> 0 <br /> dim �c <br /> ZONING ADMINISTRATOR Flani <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> J N O U H O <br /> Aefmi+ M6LG e fD C7 gt l e.-&Sen <br />