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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS = <br /> OWNER JCR tj_ �l.otaTEEL�2,Qj_1f-_7&3- Y9Y"87 - 0 <br /> MAILING ADDRESS 3 /�� /� �O �0 �.� Y l� a b"—,p.10 I n <br /> PROPERTY ADDRESS r�A h,c_ ` b it <br /> LEGAL DESCRIPTION 6 e e— <br /> /� /9Jl <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE$ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT L7 ` 3 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ 2 <br /> STRUCTURE/ADDITION USE: UGL-i'Q o Y <br /> (Nome/Cabin; C ercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTO A U1 k <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS A _� <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n C <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 m 3 <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, c3o <br /> AND INDICATE NORTH (N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <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. 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.----"' i <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. l y CIA <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE <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 y n <br /> NEEDED. <br /> VJ <br /> THI5 PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW: I �^ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. _J n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION I5 RESTRICTED ALONG SHORELINE. H a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPFCIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5, ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. £ <br /> 6. <br /> 7. <br /> 3 33 " -a. .7J3, <br /> I declare that this application ,correct any accompanying I ac howledschadule)t as been examines of r t and to l a best or my 3 0 a � S <br /> knowledge <br /> rmatio and belief It Is true,correct and complete. I acknowledge that f am responsible for Me retail and accuracy of all m aa= P "1 <br /> Information contained <br /> providing <br /> In this application upon(induding any County <br /> of hying schedule)and I further declare her I recognize perhatmit. <br /> this a E.➢ ➢ m u' <br /> Information I am provliy t will be relied upon by he County of Burnett Wisconsin Ins Information <br /> wham pr m Issuen permit I $ '- a`=' <br /> I accept all liability that may beo result ch rg County of Burnett relying county <br /> this Information 1 r authorized <br /> Inrnan <br /> this <br /> application. I agree de permit county <br /> esatla n charged wRM1 time <br /> the purpose <br /> county onspection or other au[M1orized person to have <br /> access to Me above-described pr Ises at any reason a tlme for the purpose of Inspectlo^' <br /> //ll = .nm6a gogo � <br /> OWNER'S SIGNATURE A/✓�/ m a c,, am H C <br /> (datel. B 2' <br /> JUN 1 �ZONING ADMINISTRATOR TOWNSHIP PERMITS MAY BE REQUIRED BURN(E7T COUN c m <br /> / THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANC6�ONING <br />