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SQ/ <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> AP�PL/ICATIO�NlI FOR LAND USE PERMITS = y Iln <br /> OWNER TELEPHONEgd('/ <br /> MAILING ADDRESS`(-7 L/O/V �cJ \ ✓ T./�I Y7d41J R PROPERTY ADDRESS / o <br /> �9 Na4util �mai� �1�s5� <br /> LEGAL DESCRIPTIOtrI Z P� W)IZ ` I✓ (I� � / �lmV It ( t <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDIT-10 D IX❑ GARAGE/ACCESSORY STRUC URE 0 <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO 0 STAIRS C FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION❑ CO�MERCIAL�CCESSORY STRUCTURE❑ 3. <br /> 41- tr 7�'VV// z <br /> STRUCNREJADDITION USE: I° <br /> (Home/Cabin;Canmeroal Business;Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: <br /> m o hhl <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS .l <br /> WILL BE RETURNED. rn <br /> = W H <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) n C' <br /> Uo <br /> 1. 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 v <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING($)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD,(Q BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARKYJ <br /> °C Su <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(0)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. S oji <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 SU <br /> NEEDED. tj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � F <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V x, <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. {z� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER `) <br /> SETBACK AREA. C <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> N TO BE USED FOR HUMAN HABITATION. <br /> 6. e117)If Fv, 3v' V36 ' C,36, � O <br /> V On.�y. - n.✓ ✓�x Q I <br /> zx >nnnn > om <br /> 1° � 333nd _ ,� <br /> I declare that this relief <br /> iIse,correing t and <br /> accompanying I acknowledge <br /> schedule)has been examined by r and to Ned ac u ac <br /> my <br /> knowledge and belief ii Is true,mrreti n(including wa. I acknowledge Mat I schedule) <br /> responsible her ec detail and accuracy of all rpm a y <br /> information containedpoyiiMiwillberatied upon <br /> bthe County of Burny ing ett Wisconsin In detrther miningdareher t rissueaaMrt. I �.> > m ,° > <br /> information lam providing willberelieduponrruft County of Burnett Wisccnsinlndehrmatimw a.[mods,lin permitI <br /> further accept all liability Mat a boa resulb of Me Ceunry of Burne relYin9 on Nis informationlam previdi�g in Nis <br /> application. lagree Mpermi ryafricials charged wlM adminirt ati grnuntyonumncesor Mherauthorizedpersonto ^ <br /> have access to the above-des etl premi sa[anyf abletlmr M1a ' rp se of inspection. a D 4Y n <br /> OWNER'S SIGNATURE ✓e '( n <br /> (daft) <br /> ZONING ADMINISTRATO Fox a <br /> .. .,' � <br /> OWNSHIP PERMITS MAY BE REQUIRED' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �C 80088 <br />