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C O <br /> Burnett County 7410 County Road w No.102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERM S a1 <br /> OWNER / \ ',e/ /(62T / HONE <br /> TELEP <br /> CCC JJJ /JC— ` —1 (/14 <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS Z7 Rb . <br /> LEGAL DESCRIPTION ��� �/•�/L'e '.S S�F6 6� f/s �.t'L r. <br /> TYPE OF PERMIT(SI SINGLE-FAMILY DWELLING,❑ ADDITION❑ DECK❑ GARAGE/ACCESSORY STRUCTURE❑ 5g <br /> BUNKHOUSE O 59.692(1V)GA7EB0❑ STAIRS❑ FILUNG/GRADINGF CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITIO ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S S <br /> STRUCTURE/ADDITION USE; Q L Q c <br /> _m':/ ^e�: m: c. w <br /> BUILDING CONTRACTOR: <br /> C <br /> A PLOT PUN MUST BE PROVIDED ON AN S�h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLAT PLANS <br /> WILL SE RETURNED. yDy <br /> DIRECTIONS FOR PLOT PLAIT DRAWING: (ARIAL OR TOP VIEW) L L� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. �{- <br /> 2. SHOW THE LOCATION AND SIE OF ALL EXISTING BUILDMGS/SIRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) o <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 l7 O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES d s <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. n' p. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. _o I T <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGIN O <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. BUILDER,CONTRACTOR,ETC.,THE <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STARED SO AN ON <br /> NEEDED. SITE VERIFICATION MY RE DONE WHEN <br /> C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. lz <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. "� C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. CN <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC„ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 1 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGEISTORAGE ONLY. <br /> 6. <br /> NOT TO BE USED FOR HUMAN HABITATION. O F <br /> O <br /> 7.I derlem thatt4 appbratbn(awndlnp any Arno PwrOV schedule)has been enmlnetl by me and to the beet of myknowledge Rfl. <br /> I aWb@t adt In ru wand oomgeas I adumwWge that I am repmWble for the detall and acc,my or aB aV: <br /> WdonvwUon lam aPPnCWM(Including arty acmnPanyhq mdmduls)and I further de I that I recopntre that thb a� p r $ <br /> pm heft WIN he rebad upon bribe Comdr of BunmD Wisconsin in determining �' >m <br /> rurtlw amaptaShebRnythatamyha msuRortha hq Whether to lmrmR. I F!� Ear; a <br /> applkadon. 1 aprp he OVA"W surhatt mlylnp on thm irdoramtlot:I am provhfhq In thb <br /> dwpd with admlNetratlnp roraAr autlforlead to C(%' <br /> have aocew to the abart wihedd atfor of InspectowL S <br /> / <br /> OWNER'S SIGNATURE <br /> q .� <br /> ZONING ADMINISTRATOR n H " x <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEA gt FRO DATE OF ANE ` j. <br /> d- lP��'-l�✓ �'L�IeLI' fD �OL.hTP1 'GL✓ l cl �` / �� <br />