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C O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator < (� <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER / // - n TELEPHONE /O2_7 52_ 73el <br /> MAILING ADDRESS ) .3 71l q)l�j /1l2 <br /> PROPERTY ADDRESS /O1)3 Y>vlloul truer^ roar r <br /> 0 <br /> LEGAL DESCRIPTION - /l 14 ,5 � C/lca!PAY.e,4 iJ ti <br /> SINGLE FAMILY UVVtLLINU 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION/W STAIRS ❑ <br /> �. <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADDING 0 CAMPING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK 0 0 <br /> STRUCTURE/ADDITION USE: dClu.v4 S�t-Otu C,^ I L{� /�DOMI, o <br /> (Home/ abin; Commercial Business; Bedroom; Deck; etc.) <br /> q curds <br /> BUILDING CONTRACTOR: / 0' ,1 fI +4)4L /�C�'P�t�YONa� OO <br /> A PLOT PLAN MU Be PROVIDED ON AN 6 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 2. <br /> WILL BE RETURNED. pk.W o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) I O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r, o <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) N �Wo <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK e. <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. w <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES CJ "I <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. y <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 <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: ICN <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. IIS^V 7l r <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. N Z O <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. ?t3?At- 67raA&M)0#) eF Nna"Nfr rs ,4101tea A 1500 SfmW 'Q0i (Sse CA-sloe S&+A) <br /> E <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and[o the best of my knowledge n c a A M <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuraq of all Information H �, c S. <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I 3 c w c ? w <br /> am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> 2: 9 N c N U o b <br /> described premises at any reasonable me for the purpose of Inspection. a ,,,o tri <br /> 4 c� t>ri w N -" <br /> OWNER'S SIGNATURE (date) <br /> ZONING ADMINISTRATOR_Ti a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Pem i � �p <br /> � def fie/ � i led to �Uar (a )d ) C' i � s g o <br />