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" z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS y: <br /> _ o <br /> OWNER -Dv_N t' 1 I JOG TELEPHONE��3 x.36-_, 69`7 <br /> MAILING ADDRESS �j222J�/�I4`/ �? /.�- /V I _/oeZ�q-7O 1 �6 <br /> PROPERTY ADDRESS OL6 J/Oy /Q'kl C�Y�, (I Nf /%(f6�Gj1/' 2 �GIQAICL < 1 <br /> 0 <br /> LEGAL DESCRIPTION ,JVDI/1,6 / W o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION O DECK GARAG ACCESSORY TRUCTURE)q �' <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r' C6STRUCTURE/ADDITION USE: 64&4TA" "7' (.0 SCJ • a� �Z� �} ` o <br /> (Home/Cabin; Commerc al Business; Bedroom; Deck; etc.) ase. AfT4 ow gc. -1X/ <br /> BUILDING CONTRACTOR: C.' ci W <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 92 XIt J9HEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. F c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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, C> v <br /> AND INDICATE NORTH(N). J N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) p e V I <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <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 RJ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C, y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE 7 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. (T) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. � I <br /> THIS PERMIT IS SUB]EC7 TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER IU <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> e. se6bac64s IEr Ueri&ce ApftieoC AW.1. 4012 y <br /> 7. Q A A O O O d 1 <br /> I declare that this application(Including an accompanyingschedule has been examined <br /> PP ( 9 Yc ) of r t and to the best of my o M I ? w <br /> knowledge and belief h is true,cornett and complete. I acknowledge that I am responsible for the detail and aauraq of all <br /> information contained In this application(including an accompanyingn 5 => <br /> PW ( ng Y schedule)and I further declare that I recognize tiwt this �.Y 9 to <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in detemNning whether to Issue a permit. I �:n a = Y <br /> further accept all liability that maybe a rewh of the County of Bumett relying on this information I am providing in this <br /> application. i agree to permit coupq officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described p M any reasonable time for4he purpose of inspection. m <br /> V a p q65 SO SS g <br /> OWNER'S SIGNATUR 1° L to v,m <br /> date) c H a 6: <br /> 14 v <br /> ZONING ADMINISTRATOR <br /> TOW HIP PERM MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS 'RPR 4 2012 a U <br /> u 0000$ <br /> BURNETT COUNTY <br /> ZONING <br />