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l n z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning AdministratorVIA <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER 7 �7 TELEPHONE <br /> e . 15 -9 '77-C(c <br /> MAILING ADDRESS > 3 G i"— S t r� w. n L✓-1 5 LI 00 �� o <br /> PROPERTX ADDRESS =� �� <br /> 3g �:z 9 'A Oma. [)'?n 6 ID.r ,/� sw yoC) <br /> LEGAL DESLRIPTroN P,,� aF Gov /dt3, mac. /2 �'SG/dl �f/SaJJ 5�,�rs3 (�o�9 csN u. tzA 211111 <br /> TYPE Of PERMrT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS. FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> JFK/2 X 12-ov W ,59,692 (I v) 4 SSuir fv 244 (s w <br /> sTRvcrURe/ADDrnolvvsE: <br /> (Nome/Cabin; Commercial Business; Bedroom; Deck; etc.) k�� <br /> BUILDING CONTRACTOR: <br /> ti <br /> 7 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS I o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) I Y� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c'ul <br /> d <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, <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) U G <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 6' l <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 (OF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINNE& <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 V{ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. � o <br /> d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN X31, <br /> NEEDED. ' � r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C r <br /> o I i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. VJ z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q I yy <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 <br /> SETBACK AREA, d 1/ <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. C7 <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> R <br /> 7. } >g�e�^cT>o R�1t r1O, � 3B �0 � �. 'r <br /> I declare that mis apapplication(�heing MY '+PanYIP4 schedule)has been examined by me and to the best of my B a,� 33gg <br /> knowiedge and belle(it Is true,correct and complete. I acknowledge that I am responsible for the detail and axumcy of all m E w E, <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> Irwormatlon I am providing w!0 be rolled upon by the County of wgmett W*WnsM is detarmlMng whether to ise's a permit. i <br /> further accept all liability that may be a result of the County of Sumett relying on this information I am providing in this (P- <br /> c !n N: N <br /> application. I agree to permit county off vials charged with administrating county ordinances or other authorized person to have <br /> q $ <br /> rw <br /> access m the above-descnWd promises at any seasonable,cane for the purpose of Inspection. <br /> -�PEVE � �$ go $$ y <br /> p,a H <br /> OWNER'S SIGNATURE 9 v. m F7 m"'0 <br /> ZONING ADMINISTRATOR (date) <br /> 10 2012 y <br /> a <br /> A e : Fe tl1 <br /> e. n <br /> nrnurrTr�IP <br /> PERMITS mwY BE REQUIRED r srrr,w BURNETT COU <br /> ZONING <br />