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c)nslje CIO- <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS a IZ� <br /> N \ N <br /> OWNER �Rv/D TELEPHONE bS/ - '1S'�iS7D rv�\ <br /> MAILING ADDRESS \ p <br /> /0933 P,4Ld4'9, , Allt At. :5T/a"4 tP Mft SSb�2 <br /> PROPERTY ADDRESS <br /> GI <br /> LEGAL DESCRIPTION c F, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION Of STAIRS❑ <br /> TYPE OF PERMIT(S): I� <br /> FILLING/GRADINNG�❑ CAMPING <br /> CUNIT 0 BUNKHOUSE ❑, 599..692(1V))Gn <br /> �AZEBOO ❑ DECK❑ y <br /> STRUCTURE/ADDITION USE: e1W sc un iOU �� / 1a`� 1 e a p� <br /> (Home/Cabin; Commercial Busine s; Bedroom; Deck; CL .) V 2 3 <br /> BUILDING CONTRACTOR: j5 Con/S7 — S'ELj' EA4pthPC <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 hh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n C <br /> WILL BE RETURNED. <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) R a <br /> o' <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, v <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) TJ I3 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. J z Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES A <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 1 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 9 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. s <br /> R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. e m w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: s <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <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 <br /> SETBACK AREA. b <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> ;y >nwQ> v <br /> 7. ' n ° � a2. F7 <br /> Rs- pr^ _ <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o c 2 <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I $ 3 ram a <br /> IV <br /> liability that may be a result of the County of viding will be relied upon by the Burnett reof lyingi on this Informatioconsin in n I am providing lwhether to imon this aue a pplication.furtherree tall n H g N U g <br /> permit county officials charged with administrating county ordinances or other authorized person bo have access bo the above- <br /> described premise any reasonable time for the purpose of Inspection. <br /> 3 g <br /> SIGN HERE <br /> (signature of owner or bulkling contractor) (date) o > E. <br /> g w t1l <br /> ZONING ADMINISTRATOR a <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> w: H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �o <br />