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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS = <br /> OWNER 'I-- r1 TELEPHONE �12_6�Zpg— Ic <br /> MATING ADDRESS /VJE3 3r <br /> lZ9P�1M1 .1N /rhtc6 G u-e� .Q'120 R..L1TL` rlac, Csn'I - <br /> PROPERTY ADDRESS h <br /> [vi=3 Zi�j�pe' 2r6�G 5Q(��)a 12 WS Sal PO <br /> LEGAL DESCRIPTION # <br /> LOT3 C.0 aTTFTi;L�e St 17, <br /> TYPE OF MEPHITIS): SINGLE-FAMILY DWELLING❑ ADDITION❑ DECK❑ GARAGF/ACCESSOR- -11---1-1----- <br /> BUNKHOUSE <br /> TRUCTURE BUNKHOUSE❑ 59.692(1V)GAZEBO)< STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ Q <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ \\ <br /> STRUCTURE/AODITION USE: ST/1}QS TO L I - v DLc(d G L110°'" }-1. LzLL IV Jf <br /> (Home/Cabin; Commercial Busi m; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A < <br /> A PLOT PUN MUST BE PROVIDED ON AN B'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PUN DRAWING. (ARIAL OR TOP VIEW) _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. _ p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW v <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). i <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) T <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK - Ql <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. - <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. I <br /> S. INDICATE IF A WALKOUT BASEMENT 15 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 p Z <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE <br /> PUNS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN O <br /> NEEDED. �r VK <br /> THIS <br /> THIS PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> L DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> L REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br />-- - <br /> 4. - NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ITS G <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY, <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> Z. S{10Rk-LAp,.P L31>PPP2 OA1SIr.wT S-9 -0' z Y' _ _ <br /> I declare that that this application(including any accompanying schedule)has been examined by me and to the hest of my -cC e �, f -+ <br /> Knowledge and belief it is true,correct and complete. Iacknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any amompa trying schedule)ano Ifurther declare that I recognize that his = - <br /> information I am providing will be relied upon by the County o rnett Wisconsin in determining whether to issue a permit 1 <br /> further accept all liability that may be a result of the County nett relying on this information I am providing in this T - <br /> application. Iagreetopermitcountyoffici chargeda wi nistrating county ordinances or other authorized person to <br /> have access to the above-de re s at any rea It time for the purpose of inspection. (� <br /> OWNER'S SIGNATURE S i tv o - - - <br /> (nate) <br /> JJJ//yT m - v _ 7 <br /> ZONING ADMINISTRATOR- /y, ' <br /> d a to <br /> TOWNSHIP PERMITS MAY BE REQUIREDI R c F- <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ <br />