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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 0 ° <br /> APPLICATION FOR LAND USE PERMITS ` <br /> OWNER TELEPHONE 6S 1-770 -E>4/07 o (5' <br /> MAILING ADDRESS O! <br /> AUcaply <br /> PROPERTY ADDRESS <br /> /Uma 64,jt CIL G1kNfsB��y � .r� y a o <br /> LEGAL DESCRIPTION <br /> L6 I�LE�.3 rcM/ dak< i/,`E� �4ddT,i,m <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 11 ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE IOX `F' <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o <br /> STRUCTURE/ADDITION USE: a c <br /> (Home/Cabin; C mercial Business; Bedroom; Deck; etc.) i <br /> BUILDING CONTRACTOR: 47ac46 L A A".) <�26rc Lr 5' In cO <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> c <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. ^- <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW toO B <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <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) $ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK 5 ti� <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIM NS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAIN FIEL DF AND ALL DISTANCESRj <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. o' m <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 914 <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 /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- <br /> Yr <br /> 5�4- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z N <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 <br /> rt a_ p7 <br /> w � 333go— '� <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a m w w a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this m c, aa m e <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I 2 - E:— <br /> lay <br /> further accept all liability that may be a result of the County of Burnett relying on this Information 1 am providing In this Q r w—'n 4 7 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person W have " O,°p, <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. m r w'A�4 Y <br /> _ 3 '+1 w y goo ggy <br /> URE c <br /> OWNER'S SIGNATC �(> /�� �D f° a a ry n w -n O <br /> (date) <br /> ZONING ADMINISTRATOR \1 m <br /> w Q '2 <br /> n <br /> � A <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �/✓Y)`��'d- I P�'}G,r �(� `� ��' �1c�P,rs CD✓�-�r'r.�GftOn � `" g � � ` g <br /> 3—Jc(--lD <br />