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C O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS N <br /> OWNERmlic, ,S? ��LTELEPHONEZ.er 7�'3 <br /> o <br /> ` Q /(/o✓woo 9 <br /> MAILING ADDRESS ( l l (jr�sl I C� I ^%Aj <br /> t'f d� <br /> PROPERTY ADDRESS fkc�$7- 9) <br /> LEGAL DESCRIPTION 1 ! 15 <br /> �1 ,5� T38N 2 '✓ C,14 Z247-0g 1100 s <br /> TYPE OF PERMrr(5): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK ❑I GARAGE/ACCESSORY STRUCTURE ❑ _ <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS ❑ I G/GRADIN MPING UNIT❑ �- <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COM ACCESSOR TRUCTUREX <br /> STRUCTURE/ADDITION USE: N�-\_XQML: — AC1C4!5—SStla`e S'I7'i-✓GTt avUl'..y c S <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: QWitiEYLS <br /> n <br /> � N <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. 0 c C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C Cl <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, o <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) P <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. ty <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. 5. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 9j <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 1 �J <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONS <br /> NEEDED. ITE VERIFICATION MY BE DONE WHEN ,..1 <br /> GO <br /> G� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a7 <br /> (b � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. \ <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. U <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TOB USED FOR HUMAN HABITATION. , > 'f <br /> ryfl� p 1 <br /> 6 <br /> YaU,._S ' — l0 Frdn-T ✓aln-eld, - 1 PO <br /> 7. cS1-dt (Of iikAL 70 aap <br /> n 8 3 3 3 oK $2. 1 <br /> X33cc. = , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my m o,6 o o . <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application (Including any accompanying schedule)and I further declare that I recognize that this o E. D D m <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I ? r' > <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this v `a 9 R _ti <br /> application. I agree to permit county a dais charged with administrating county ordinances or other authorized person to have a p I n,6 o $ $ <br /> access to the above-described pre at any reasonable time for the purpose of Inspection. S N R 8 rr, c3 <br /> p � yg8o80 . <br /> OWNER'S SIGNATURE �dG R A a o'. <br /> aS Re <br /> ZONING ADMINISTRATOR �Jl✓y) F l al) t[)a , (date) <br /> TOWNSHIP PERMITS MAY BE REQUIRED p . <br /> THI PERMIT HALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ^"` ` <br /> y/YQ y/� /J� (((��� (A.. N b9 Vf b� .. <br /> �r D / 1 I1. �� nW le Ch <br /> ' p J N to to 4i <br />