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N 1 <br /> 3 U <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator - = <br /> APPLICAr,TION FOR LAND USE PERMITS 4 U <br /> OWNER D �ANr` M , I^'!Tr TELEPHONE \ <br /> .1 ��G �9—G 1 U� (D 11 -51/(62 <br /> l v <br /> MAILING ADDRESS .-J, 5 kL a,l y ��e�'_r -DT <br /> U/4 b Co 33e <br /> a9o3q Ti-eRs�rz s(n�� �,r, 0 <br /> D- <br /> PROPERTY ADDRESS - ` J am— <br /> LEGAL DESCRIPTION I I^` <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK❑ ARAGE CCESSORY STRUCTUREA <br /> BUNKHOUSE 0 59.692(IV)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 q <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: rs-I�.Tcf a els,, O <br /> {� one/Cabin;Commeroal Business; Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: Se I T N <br /> T 3 <br /> A < <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vt X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 _ <br /> WILL BE RETURNED, r <br /> r. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW h <br /> BUILDINGS/STRUCTURES(NS),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J <br /> AND INDICATE NORTH(N). p <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S) 9/ C <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 o' i <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES CD =�I S <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. /11 -7 -I ftj <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE " Y (n <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER.TU � C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN " ( 1 <br /> NEEDED. 1 IIA <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Y rV� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'j A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. w i <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER r,1 <br /> SETBACK AREA. VN <br /> S. ACCESSORY STRUCTUREIGARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 1.-rN�OT TO BE USED FOR HUMAN HABITATION, p <br /> 6. Army * to > k0�'h �M 0,�.,elU/�01� <br /> 7. 7 > nnnn > O <br /> I declare that Nis application(including any accompanying schedule)has been examined by me and to the best of my 3 o Z Q ,o.. �IF <br /> knowledge and bellat It is true,carred and complete. I acknowledge Oat l am responsible for the detail and azstrraoyaf all <br /> Information contained in this application(Including any accompanying schedule)and Ifurther declare that l recognize that this <br /> Information l am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I a o. g�— ' <br /> further accept all liability that may be a result of the County of Burnett relying on N4 Information l am proiding in this i 15G'�3 = 1n <br /> application. IagreewpermitcountyoRdalschargedwi adminiWaUngcountywdlnancesoroMerauthorizedpersonM <br /> boxes.toNaabaaa-deaGd on gmmises at any reasa One for the purpose of Inspection. ID <br /> OWNER'S SIGNATURE (✓' ( 3 x 88 . 8 8 <br /> p g A <br /> (date / 0//,3 <br /> ZONING ADMINISTRAT 5x.a5 & a 5' <br /> S 5 : 5 , <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 3 <br /> 8: .. <br />