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c Z <br /> Burnett County 7410 County Road K,No. 102, Siren, WI 54872 Office of Zoning Administrator g I 9 <br /> APPLICATION FOR LAND USE PERMITS <br /> _ � n <br /> OWNER JAMtS 13rer,d-, (--ASS-r-e <br /> TELEPHONE <br /> MAILING ADDRESS + Z 3`� �t-f� ` La �� fMJ.7eJcf r o 5-y`3614 Ln <br /> l <br /> PROPERTY ADDRESS LI ['g C,Oun `�� C WS <br /> J J < <br /> LEGAL DESCRIPTION /I[70J 1,,4 b EX .5i-3z" <br /> o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING D ADDITION if DECK❑ GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE❑ 59.692(IV)GAZEBO❑ STAIRS 0 FILLING/GRADING❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIALA ADDITION❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> "t <br /> STRUCTURE/ADDITION USE: cW-1L1 o <br /> (Home/Cabin; Commercial Business' Bedroom;Deck; etc.) <br /> BUILDING CONTRACTOR: - 1, z " <br /> .g • <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS A 9 <br /> WILL BE RETURNED. G' <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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, <br /> AND INDICATE NORTH(N). N \ z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) d ° <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Z <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. i t <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES RJ <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. yl P u, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. G SL) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE 1 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. UL <br /> NOTE: BUILDING/SIRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN IS- y <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- U <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. tom' Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. T2 x <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �G <br /> 4. NO STRUCTURES,INCLUDING RETAINING WAI I ,ETC.,ALLOWED WITHIN THE REQUIRED WATER U� <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. -)^&ry pelrAtif b re loc+4 Se06ic 6nIL 6 ie IStKi PFfOr 6, Co trattnrca S pgjedt <br /> 7. Permit fS%Wd dS kf gwab*ce Rest 4*&*— IBC Acr )?D� *ifCt AA&MY ��10�2d2 'o a o Op a o ro <br /> . xz � ea3o=: � <br /> I dedare that this application(including any accompanying schedule)has been examined by me and to the best of my n _ ?e M <br /> knowledge and belief R Is true,correct and co nplete_ I admowledge that I am responsible far the detail and accuracy of all <br /> IMormatlon contained n this application(including any accompanying schedule)and I further declare that I recognize that this <br /> hnformatlon I am providing will be relied upon by the County of Burnett Wsmnsin N dete mini g whether to hseie a permtL I m �: <br /> Further accept all liability that maybe ajamflispf the County of Burrett relying on this Information I am providing in this v ' <br /> application. I agree to permit arged with adrNmsRadng county oNYances or other aWn n co have 8 <br /> - a¢ess to Me above-described rt Y time far Me purpr A inspection. w n <br /> �// con 66$�oogy <br /> OWNER'S SIGNATU / �� (date) <br /> �� o H o c m n N_O <br /> ZONING ADMI ct 2A . <br /> y n Fcm <br /> 3: <br /> TOWNS P PERMITS M Y BE REQUIRED <br /> THIS PERMIT SHAG EXPIRE ONE Y R FROM DATE OF ISSUANCE u N o 0 0 0 8 <br />