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c n Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administratorg 3. 0-)J <br /> APPLICATION FOR LAND USE PERMITS - (A <br /> OWNER TELEPHONE 0.ed- 6Sl r�E/-a yl7 c. <br /> .-'cini<2 �' C,hrl � Kehler <br /> MAILING ADDRESS " £O <br /> t1o7 (.tli//o h&I W a AoU7Dnkal, /Hk) SS3oS— r <br /> PROPERTY ADDRESS /,rf✓J0. a , <br /> - _ 6758 )4irt14kidlell �OOCC. c <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE❑ 5 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO ❑ STAIRS 0 FILLING/GRADING, CAMPING UNIT❑ <br /> o <br /> COMh�ERCIA4 BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> -STR �e a pro,f(ct�•' :..� ass�r..ec(, StYar�lola,,,,C-hand �cp5o�l re aur.,tfly��n refore z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) "fls (�eQd w) o <br /> BUILDING CONTRACTOR: n p <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o_ <br /> WILL BE RETURNED. <br /> ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r0: <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C m <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, a <br /> AND INDICATE NORTH (N). N Z <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 2 O <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. p r. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES q mow) <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. a w <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 TO o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. (Q <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN qj <br /> y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS.OF PERMIT. n Cn Q <br /> Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z O' <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. n 0 op 8: <br /> L " m 3 3 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my o,° 9 $'^.°r <br /> knowledge and belief It Is W 2 9 e,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all d m 2.Fad. <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 relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <br /> w <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this o n c L.L,—«#10 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ,� o <br /> access to.the above-described premises at any reasonable time for the purpose of inspection. 8 5 8 r f7 <br /> m �� aoS8a <br /> lel �Cf I�l� OVloS/d009 a 8 <br /> OWNER'S SIGNATUREAf p� (date) o H > °tt y Z <br /> is e,yT ° Yf <br /> ZONING ADMINISTRATOR y ° : ° M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Yf�pN NyN <br /> N N O O O O <br />