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U <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS _- <br /> OWNER ��C�-1�9�L L1lE/SKE TELEPHONE 7/5 <br /> _ / SLI-37'16 O <br /> p [O <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS //873 /2C/ F �YG✓1/-,S��U/� /-U� <br /> 1 v <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ _ <br /> BUNKHOUSE 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING/❑ COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE:- L lJ��� - NU PIUy/19(ASr <br /> / (Hmn,/Cabin; Commercial Bueiness!''Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz%Il SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS = 21 <br /> _ <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING (ARIAL OR TOP VIEW) _ c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW q <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, B <br /> AND INDICATE NORTH(N). L° <br /> 3, SHOW DIMENSIONS IN FEET OF THE FOLLOWING (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS) '� = <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. Z' = d <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. 4 <br /> 5. 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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. w ) ' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN — (� <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. " Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <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/BSE USED FOR HUMAN HABITATION/. / f <br /> 6. NV /)1(,t^L}.13, 7z b e <br /> (JDl fS/JU s 3 1 wn UlXm a <br /> 7. <br /> >n nnn > ct <br /> I declare that this application(inclutlinq ante nymg' a le)has been examined by me and to[M1e bert of my <br /> knowledge and belie)it is true,xneR antl plete. 1 at owletlge[M1at I am res _ '� `-' - �- 4L X responsible for the detail and axuracy of all <br /> information contained in thisapplicatio n u inganya ampauyingschedule)and Ifurther declare that I recognize that this _ = > a � <br /> information[am providingwll be rel Up ytheeo ryof melt Waconsnndeterminng whether to issue a permit1 _ o �D <br /> fuKM1eraxept all liability that ma ar 'it <br /> a the a ryof me relying on this information I am providing In this LLLddddEEEE..�Liiii�,FFLLLL <br /> appli.ton I agreetopermlt co Teal c rill d thatl nistra ngcounryortlmantesor otherauthor zed person to <br /> have axess to the above pe sat n a eti for he purpose of inspection. y f) <br /> c oD <br /> OWNER'S SIGNATURE scr n <br /> (da <br /> ZONING ADMINISTRATOR <br /> �-2 2013 <br /> OWNSHIP PERMITS MAYBE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS S COUNTM <br /> ZONING F N <br /> �� o �000 <br />