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ON COMPUTER/SC ED a <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> / <br /> APPLICATION <br /> fff FOR LAND USE PERMITS = = a I r <br /> OWNER (/ y(,tI( ,/'(J , / �O / _ O TELEPHONEgIC _qW_ lni) ft O <br /> Ft11 lllh YJ,�N /V l`, 7Uv O Yro'o1 O <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS uv / IL �% 0 <br /> 7 r <br /> LEGAL DESCRIPTIONiS,I. �.� w L I Z ' I ✓ / 4 � / d! PA ` / 1_q <br /> P <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING li ADDITION n D CK❑ GARAGE/ACCESSORY STRUCRIRE❑ <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO 11 STAIRS❑ FILLING/GRADING❑ CAMPING UNIT 0 a <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑�'T7'CO{MMERCIAL CAE,SSORV STRU/CTURE/❑1/ / l/p S <br /> STRUCTURE/ADDITION USE. C_ � N? l'laA�t Tiaw�' 1'(66, 14 o o <br /> 0 � (Home/Cabin;Commeraal Business; Bedroom; Deck; etc.) L1 <br /> BUILDING CONTRACTOR: <br /> r 3p <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'A X11 SHEET OF PA O — <br /> WILL BE RETURNED.` <br /> n 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN( SC/� C <br /> 2. SHOW THE LOCATION AND SIZEALL BUILDING o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING <br /> DECKS, <br /> , PORCHES /�,� I a <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILC <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENTS)l �,/'/�� /y1 m <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS, f�/Kr/F' jV o <br /> 9. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST), Y V -ZTO BUILDINGS, ROADS, LAKE, LOT LINES <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW "I <br /> 6. F SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENG F <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. R 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED! <br /> NEEDED. 1 <br /> THIS PERMIT IS SUWECT TO ALL CONDITIONS LISTED BELOW: � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^ IA <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 9, 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 /> N TO BE USED FOR HUMAN HABITATION. £ <br /> e, /inff Fa, G ' Cabw 0A.I - w -la Qom e� <br /> 7. <br /> R n R 3 3 3 <br /> knowledge <br /> thatthisbeliepit is tre,correct ancomplete. Ing any ngnowledle)hage tbam een exaresponetlbyr e and thedtail and accurist of acy <br /> inormatio andbenef itishrue,mrrettanticludin[e. Iaccompaning sc ] ule)and I furthle erdeeare thtIreccurary ofall y _n_n my <br /> information<ontainetl in tM1is appliw[ion(indutling any accompanying schedule)and Ifurther declare[ha[tre<ognize that M1is > <br /> information I am providing will be relied upon by the County of Bumert Wisconsin in determining whether to issue a permit. I m a <br /> funhe,uxaptallliabilitythat a bearesult fine <br /> of County Bne relying on this information l am providing in this y° <br /> application. I agree to permi ty oKcialz charged with atlan ur.ati gocunty ordinances or other authorized person to m - : <br /> M1ave access[o the <br /> above-de etl premi at any able tim hep rp se of inspeRion. 3 3 D -_H <br /> Tem <br /> o > <br /> OWNER'S SIGNATOR' - '" • �� ���� 3 <br /> ate �z�a, >y'2 mno !C 0. 0 <br /> ZONING ADMINISTRATO �� ISO a a r <br /> ,,,•Y <br /> vow PERMITS AY BE REQUIRED' <br /> THIS PERMIT SHALL EXPIRE ONE Y AR FROM DATE OF ISSUANCE O 3 <br /> Uu8000 <br />