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/ M o <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE je/'- V19— S//,3 o <br /> RDde =I �F / of l'I LceA1 � / nsGA/ <br /> MAILING ADDRESS O <br /> 9Ra y FKaY DTI ? A 0 so s <br /> PROPERTY ADDRESS <br /> N L34.s_t l'a !!e__ <br /> LEGAL DESCRIPTION^ Y2 .S Q. S L.J <br /> TYPE OF PERMITS): SINGLE-FAMILY DWELLING$6 ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE❑ - <br /> BUNKHOUSE❑ S9.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> r <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ - <br /> Z <br /> STRUCTURE/ADDmoN use Al c(.Z Dke[Ltn sp /6a/e <br /> n (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) IIILIa��ir <br /> BUILDING CONTRACTOR: /D b G 12T kA /1 n.5 G Al v <br /> O 3 � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'Az X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <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, W -' <br /> AND INDICATE NORTH (N). o Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) o R <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK "' \ ip <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. C o <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. so <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o H <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE E <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. �o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 3 <br /> NEEDED. F f� <br /> b <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: '� W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. -r-I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F 1 <br /> 3. NO GRADING OR SHOREL4NO ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. v \ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. p <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. £ O <br /> 6. /4-3-r 441L ly" FoR o•vllT� I✓Ca7G/F✓D 4yECK„QE F !s.✓SfX I+cns✓ <br /> 7. <br /> A > o on > cc <br /> n n ^ 3 _ _ $ F ZI <br /> kdeclareethatNelief it ision,correing any t and complete. yicknowlede)M1at I am examined byme and r thedtoiland best <br /> acuray 70 ,Zg <br /> inormatio ao belief itis[rue,Correttanticluding any accompa yin Mate ule)and I fureyor eclare that <br /> tIreco recognize <br /> Of all > P -I <br /> information I am Prov in g will be relied upon going any accompanying schedule) in I determining <br /> whether <br /> her I recognize rrat this = 5 > o Y <br /> information I am providing will maybe relietl upon by h e Cau ty f Burnett Wisconsin in infer atio wam pr to issue a permit I B °' - - �y <br /> furtberacceptallliabilityrmit ty aresult of the County of Burnett relying an thisinformationrIamprovitling inrso _ m' ��+/��: <br /> have application. Iagree topermitribed pemisesatls any reasonable <br /> bleb time <br /> the ptrating ure se of <br /> other authorized person to AoV=+ <br /> have access to theabove-describednprey�misesa[any r'ea/sonabl¢time for the purpose of inspeRian. m dam ' n <br /> OWNER'S SIGNATUREXQN.RDOM <br /> (date) Ei � <br /> . `L <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED d V F - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />