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C Tl Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER <br /> TELE <br /> � PHONQj <br /> E <br /> Dbe.rt L . Kopaae,K �H 'f <br /> MAILING ADDRESS <br /> 2lF I✓1 111 We) o Cary IL lioQJ3 <br /> PROPERTY ADDRESS <br /> 2935-1 eountu Hwy Lia54-00 a <br /> LEGAL DESCRIPTION / 1 L <br /> `i lJ ✓ ll(J o �' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE❑ v, <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ ) <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ o <br /> STRUCTURE/ADDITION USE: C K o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> n fffKKK„"xxC..."` <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o ' <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m �' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW `� o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <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) o <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. <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. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r J <br /> d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. f0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d 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/GAP 4Gt PERMITS ALLOW FOR PRPlATE.".ESIDEfNTAL GARAGE/STORAGE ONLY. ' <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. Q <br /> annno > c <br /> 7. rfDi R 3 3 3S <br /> a E <br /> hz � � � o . . <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge 3 0 o <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this information I <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to c e^N ; 0 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- C o.2 0 0 : o 0 <br /> described premises at any reasonable time for the purpose of inspection. o <br /> / <br /> i oil D S 00 0 0 0 <br /> OWNER'S SIGNATURE /mar /� — tC '— d FI 'p° > a <br /> n 6z yo: em O � <br /> (date) o y > o <br /> ZONING ADMINISTRATOR <i //G"' '� � y °cw' a <br /> TOWNSHIP PERMITS MAY BE REQUIRED n °° <br /> THIS PERIMIT SHALL EXPIRE ONEYEAR FROM DATE OF ISSUANCE N <br />