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P <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a W <br /> APPLICATION FOR LAND USE PERMITS y N <br /> 7 <br /> OWNER� TELEPHONE � o. <br /> L <br /> C12- - 3 ' y— NKo <br /> MAILING ADDRESS "� f `. <br /> 0 <br /> /.C/A. s f t'U"�7 Sf+✓i��, c ivc ✓ ;3-3�>� <br /> (Ju <br /> PROPERTY ADDRESS r i <br /> ���lD ? (�_ �i Lt.o�:. J-L�Cr ,�A lL'i-b��l�✓'7 "' .� >`f S�iU o <br /> r7 � <br /> LEGAL DESCRIPTION � r' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION,& DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> ro <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ ; <br /> STRUCTURE/ADDITION USE: .�UI�G-�-t C)<i <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 00 <br /> BUILDING CONTRACTOR: )'•� Lt— � ��pp <br /> � lr <br /> M � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) e <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 w o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N OD 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 J <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. d 9) Q <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 5. P <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. .C. <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. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- O Cn <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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. 8 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. �e SUL . LJarla.2e 4:r- 9000 �y S <br /> J. -�' S q fDi r O r C+ 6 2 <br /> A r1 y '3 N <br /> rt <br /> zoo Elgo5 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <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 v `—> c M N <br /> infornation I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I g ?w <br /> further accept all liability that may be a result of the County of Sumett relying on this information I am providing in this H 22 <br /> application. I agree to permit countyoffiUals charged wtth admin Ing county ordinances or other authorized person to have <br /> access to the above-desalted p/rvFises at any reasonable time the purpose of Inspection. g g iA U w <br /> i? ? l ( � � nggoo <br /> OWNER'S SIGNATURE <br /> (date) o $ P3 d <br /> ZONING ADMINISTRATOR <br /> R vv p_ T 6 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF I,SSUANCE <br /> Pe((YT& 4 Ji-71 er(hai-M ta77ma1yy � <br />