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G O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g � <br /> APPLICATION FOR LAND USE PERMITS U' <br /> N � s <br /> OWNER <br /> TEctLEPHAh .OONE �• - <br /> MAILING ADDRESS , / C)j <br /> h/fi?�& {�✓ey'Gn/✓/f 'a"gyyP 79l1A5 <br /> PROPERTY ADDRESS = J <br /> 3176A 0Z hArr <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMrr(s): SINGLE-FAMILY DWELLING 0 ADDITIONA DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 - <br /> ro <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE ❑ S <br /> STRUCTURE/ADDITION USE: 0_436UXI — / 4LJte - A#4-000A z <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) '� <br /> BUILDING CONTRACTOR: II(�N{)f '��� F�'�d1'/��L� n <br /> A PLOT PLAN MUST BE PROVIDED ON AN B 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. +f <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tn�f Cy <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDINGS) °o 9 <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 o 1 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. v, <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 o <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 ,.i <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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 17- <br /> SETBACK AREA. U11 <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. T 0 0 o n c ro <br /> � a � <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of myo 6 . . . ° ? 5 <br /> � 3 <br /> 3 9. <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 > w <br /> information I am providing will be relied upon by the County of Burnett W Isconsln in determining whether to Issue a permit. I m u ii ''' Y <br /> further acceptall liability that may be a result of the Count of Burnett relying on this information I am providing In this <br /> ty Y Y Y 9 P 9 <br /> application. I agree to permit county officials charged 4 administrating county ordinances or other authorized person to � n 2L :: ,r. <br /> have access to the above-de d premises a any nable time for the purpose of inspection. u A <br /> _ oca <br /> OWNER'S SIGNATUREn oo $ 0 0 0 „j <br /> (date) y <br /> ZONING ADMINISTRATOR I(Y) /�laat Qh 4 Z01 <br /> y �7 <br /> R C T <br /> TOWNSHIP PERMITS MAY BE REQUIRED " w 6 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE BURNETT C o <br /> PP/rvti�� lvYIe�PCGeC1 vr� �'c� S ✓� r��tis ZONING " " = <br /> T <br />