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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPnLICATION FOR LAND USE PERMITS L <br /> OWNER { /1 e� , TELEPHONE <br /> �/s c Ufr C/L /r.s19—,Cao�Z <br /> MAILING ADDRESS [ <br /> �f/.i �/rJYIIAtcS 1�^�'R/c, <br /> PROPERTY ADDRESS <br /> dr 9497 E_�CLLc'W N��L f /Xr/R✓�(,1�.(/✓� )I <br /> LEGAL DESCRIPTION F/ 1 <br /> TYPE of PERMITS): SINGLE-FAMILY DWELLING 0 ADDITION DECK IZ GARAGE/ACCESSORY STRUCTURE U, =_ ` <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL <br /> ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: <br /> r (Hare/Cabin;Commercial Buvness; Bedroom; Deck;etc.) ' <br /> BUILDING CONTRACTOR: SQL' I <br /> A <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS <br /> WILL BE RETURNED. <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. r <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, to AND INDICATE NORTH(N). _� F <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENTS)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 <br /> TO BUILDINGS, ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I' , <br /> 6. IF SEPARATE PIANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE s Icy'W�I <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN _ <br /> NEEDED. '^ r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. R ' <br /> 4 NO TURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. y <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION, i <br /> 6' 9->3 i45,A?7. <br /> vur�i[j uF ckaF ShksS /a �i 7S;S�f �ij Gt��A.i Sw Ky <br /> 3 3 3 = Z <br /> I declare that Nis application(including and y complete. <br /> I acknowledge <br /> schedule)has been responsible <br /> examined by r the d ta He Bert u my <br /> information <br /> and belie)it i is Me,correct n(including complete. I accompa yin Nate ul responsible Tor ec detare th and eccunp o/all _ - - - <br /> informationIampretldingwillWratled bobthe unity of Burnett <br /> netsWsconsi indetend I rther ining declare Iresue. ethat rmit Is _ = > a_ N D <br /> informatlonlam providing will be relie0 upon by the County of eumeK Wisconsin in determining whMM1erNissuea Permit ) 4.c' - S <br /> further accept all liability[M1at may result of Me County Burnett relying an this infomnatlonlam pmvitling in this _ <br /> application. I agreetopermit coon mdals charged witbadmi ystratias unry ordinancesor other authorized person to =T ' ?c <br /> have access to the above-de- rib hesatanyreasgpdbl le Ne puryase of inspection. > <br /> OWNER'S SIGNATURE m 7 �'-�- �9 -� - ", 8 <br /> (data) - .� _ - .r - <br /> ZONING ADMINISTRATOR SEP 1 Q 2013 = P <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> BURNETTCOUlt <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ZONING <br /> uU3�a = ' <br />