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OO O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator $ I <br /> APPLICATION FOR LAND USE PERMITS �) L <br /> OWNERTELEPHONE a c <br /> IowA�sl,C� <br /> MAILING ADDRESS ^8 cto () ?� f U S p- muer WJ. 5ySa 1T11 0) <br /> PROPERTY ADDRESS / G IW 1CC�A ' t n I O <br /> LEGAL DESCRIPTION "I— X1 yl I v> Y(4 !ec 17 J Tu jAj R I g L O <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDDITION 0 DECK 13 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT E C1 <br /> COMMERCIAL BUILDING V_CCOMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE <br /> STRUCTURE/ADDITION USE: SQ'Il S�G'NG� S�'Od' SKe- AdCc'SSUr USCW <br /> 0 <br /> (Home/Cabin; Commercial Business; room; Deck; etc.) <br /> BUILDING CONTRACTOR: 10wh'Sk' ejF o <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> n <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) t=1 p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ^- m <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, B <br /> AND INDICATE NORTH (N). I I <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 w' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O <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. 5. w+ ' <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o 4z <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. J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. ' Q <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: rr- c-> - d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <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 t <br /> SETBACK AREA. 1 <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> Do 0 o C)a0 b <br /> 2' ff <br /> Hzon � nSos3 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 9 o Z _ . <br /> knowledge and belief It Is true,correct and complete. I acknowledge 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 $ u > a d N a <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In detem ming whether to Issue a permit. I R ?w 7 <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this Q k y w'c+ !n"ti' 'd <br /> ac <br /> cess tion.to the above-desto cribed prermit m si es at any reason officials charged with <br /> time for theing purpose of Ispection.inances or other authorized person to have o w o o S n <br /> rt A Ev a gg � gg <br /> � � 'amn v, m0 <br /> 46WNER'S SIGNATU (dare) c v, 6 <br /> ZONING ADMINISTRATOR V `r I I I `anl"IQn <br /> pbi&GO io O r- <br /> G 5 is rd o: <br /> 5d°i EX asi— TOWNSHIP PERMITS MAY BE REQUIRED H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ^— <br /> PerrYi i-� p Ct-ed up b� Csa rV <br />