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z <br /> Bumett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator $ ' <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER ©Y,���� ��� l� � TELEPHONE f3-7- 319 / p rF3^ JJ / IP 10 c+ <br /> MAILING ADDRESS .7 <J ��(j n s�L�hq t5_3-073 a <br /> PROPERTY ADDRESS <br /> 6 <br /> LEGAL DESCRIPTION / //// <br /> �iGCc/I ) La/S'G <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE X ti ' <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ � r ,!� <br /> (n <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c 10 <br /> STRUCTURE/ADDITION USE: Ga f cL e o <br /> (Home/Cabin; Com ercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: CCN C S l'I C_ - n O fyll <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. c <br /> ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEWO 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a a <br /> AND INDICATE NORTH (N). J N c <br /> 3. SHOW <br /> TO CENRLINE <br /> DIMENSIONS <br /> BUILDING(S) <br /> OF ROAD, C) BUILDING MEASUREMENT(S)TO THE)ORDINARY HIGH T <br /> TO ALL LOT LINES,H W E) BUILDING(S) <br /> R MARKo O <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p �- <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES q. Y <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. , v� <br /> 5. INDICATE 1F 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 4 O <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 90 <br /> Tf <br /> NOTE: BUILDINWSTRUCfURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,j (W^ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Rn z ^' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C> <br /> F lJ <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 CP <br /> [-- <br /> SETBACK AREA. 01 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. `W'1 <br /> NOT TO BE USED FOR HUMAN HABITATION. p <br /> 6. a <br /> 7. "gfpf In 6 tsl <br /> y z gw <br /> I dedarc that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belle(It Is true,correct and complete. 1 admowledge 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 <br /> Information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I c a <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this c 'y� c in "T N b <br /> application. [agree to permit county als drarged with adminlstratlng county ordinances or other authorized person[o have m O 8 S <br /> access to the abovrdesaibed prem) any reasonable time for the pu of Inspection. w 8 w 65 n <br /> / 3 A 6 98 - 88 <br /> OWNER'S SIGNATURE �� Z// n y c e mE f] ti M O <br /> (� ate) �� ' .zI <br /> ZONING ADMINISTRATOR ll M (" �Q�(CiG 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE « ^ <br /> C b �r Lin lem <br /> t�e/m I I�f I�✓ p lea P �J <br />