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y � z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator < �1 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER LJ E-T�4 � 'j l <br /> 11^ T JkS+Y� TELEPHONE - /S'Lf <br /> TI'1 1, � o <br /> MAILING ADDRESS ' <br /> 7_7a-7 Main Si ) DanloArw2 S4V30 <br /> PROPERTY ADDRESS <br /> tr� <br /> 0 <br /> �uv9h e- < <br /> JubaiV`rSion )1Z Sec o18 E crcS Lvl`3ry r <br /> LEGAL DESCRIPTION E X W 75 r �ec, a� 7-y7 A/ R/ w - o 4- <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION X DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> -o <br /> o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: Bedroow,, Qln;11a4 P013w <br /> (Home/Cabin;Commercial Business;(Bedroom; Deck; etc. <br /> BUILDING CONTRACTOR: rS e�'T <br /> O � <br /> 77 < <br /> ° <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O.n <br /> WILL BE RETURNED. <br /> Pf a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. as <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW n <br /> �y o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, N a <br /> AND INDICATE NORTH(N). oo ? o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK '� b <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 E 9.1 <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 I i <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 G <br /> NEEDED. rf) (J-� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -1 n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Q 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. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7, py > nnnpDay <br /> 'O3 3 2 a � rf1 <br /> H3 3 0 = <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 p 2 `; 9 °, ? w <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m E. '. E. 'O <br /> a m _ m_ _ � : y <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this `0 E. y <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> Y <br /> further accept all liability that maybe a result of the County of Burnett relying on this information I am providing P ty Y ty Yin9 P 9 in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to <br /> ha0e access to the above-described premises at any reasonable time for the pur ose of inspection. o m D ss <br /> o > <br /> OWNER'S SIGNATURE �n n $ S o g y <br /> (date) V .°2 <br /> ZONING ADMINISTRATOR <br /> F4U G 17AUG 172012 ; dd � <br /> TOWNSHIP PERMITS MAY BE REQUIRED all s <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCrBURNETT COU <br /> »d: 6 <br /> ZONING <br /> � � 000a � <br />