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N `C <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator g w <br /> APPLICATION FOR LAND USE PERMITS y <br /> !j ° a <br /> OWNER 11arJ Il�I d--1 C� c I C7) 0� L)J h)/3Y7 R TELEPHONE `'0,3 1-I I�-I �IZ'J O w <br /> B <br /> MAILING ADDRESS <br /> 140`7 Law-e- QSWelsoy oR 9'7o34 J W <br /> PROPERTY ADDRESS <br /> 2-7 0�0 o � <br /> t told, = r> -TA 0V— , <br /> LEGAL DESCRIPTION s, <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITJON❑ DECK❑ GARAGE{ACCESSORY STRUCTURE pI g �. <br /> BUNKHOUSE 0 59.692(IV)GAZEBO ❑ STAIRS❑ FILLING/GRADING 0 CAMPING UNIT❑ <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURED <br /> STRUCTURE/ADDITION USE: — z O <br /> (Home/Cabin; Commercial Business; Bedroom; Dedc; etc.) <br /> I� <br /> BUILDING CONTRACTOR: r) ^ <br /> /5 333 W fir. t2 '( 7 N av man ,�y!_ K 1" 5 0 � UiW <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 X11 SHEET OF PAPER ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. 0 - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C I-- <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, p v <br /> OC <br /> AND INDICATE NORTH(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 ' i <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. i G G <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES )� SLJ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w n <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 Oi o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. l��U^� (T <br /> NOTE: NEEDED. LOCATIONS MUST BE STATED SO AN ONSITE VERIFICATION MY BE DONE WHEN l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O z C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMTITED. r J <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p _ <br /> SETBACK AREA. 1 <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. C <br /> 6. C <br /> C <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined me and to the best d my <br /> x S S w y <br /> knowledge R le ge and betrue,conett and o[NaPl9 . I aiunowledge that I arm responsble�Por deteg and aomg o <br /> hhPomatbn contained h this application(including any awnpanyhng schedule)and I further declare that I reaog�am this E_L y M. <br /> ° <br /> information I am pmvtllnp will be nelled upon M the County of Burrnatt Wisconsin in deasmai ni ng whsthar to Issue a pemdL I g $ <br /> further accept all IlabgkY that may be a rwtk Of the Ccu d Burnett 8 : S y <br /> application. I agree to percale moltY larged wildaim ng on this anoss r o I r providing In rile <br /> access to the above-descbed prem at any time for meati In or other autladxed person m have 6 @ S S o H H 4 n <br /> purpose d YsPecbm. �+ 0 0 <br /> �oH '�8y <br /> � N1 � o0 <br /> OWNER'SSIGNATU 'DA iD - 7//.3/"/3 // <br /> �' �; (date) n ca c m 6 m of z <br /> ZONING ADMINISTRATOR �J i✓Y) FIOPP/(CIC(n 6 _. <br /> y CIS$ 8 a a <br /> For <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N»«« H <br /> PPI�mi � d IP�1-{�{r�cCked up lot-) Or2kCOrtSfruc�idr� "7-/car( uUo00os <br />