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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 1 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER JTL�IZ U/(IG 60 V', 1/7/ {QNE 3i /6 <br /> MAILING ADDRESSO O K <br /> P B x aal Dvyvbu w� s p a v <br /> PROPERTY ADDRESS / <br /> 7�3/ .J ore r7ftu 6",-_& ° 1 <br /> LEGAL DESCRIPTION �- <br /> r <br /> le'r GSM V lG V 2cro SE �V 5��S Seca-8'T41ldl � 16 /al Swtss s <br /> TYPE OF PERM <br /> n-(S) SINGLE FAMILY DWELLING 0 ADDITION k¢ DECK 0 GARAGE/ACCESSORY STRUCTURE'" y <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r <br /> STRUCTURE/ADDITION USE: �d'�/ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: el)- <br /> n <br /> A PLOT PLAN MU <br /> WILL BE RETURNED.ST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n _a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m t7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m v o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 93 <br /> AND INDICATE NORTH (N). v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) E.0 o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK E. Ci <br /> 4. SHOW HEFL CATION OF THE LAKE, STREAM RWELL(W), SEPTIC TANK(ST)AND RIVER AND WETLAND AREAS, DDRAINFIELD (DF), AND ALL DISTANCES x?j _Qj <br /> i <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ) _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n z <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. <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 /> 'nX 'n' 333 C) >Ol7 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detall and accuracy of all <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this $ y <br /> Me County of Burnett Wisconsin In determining whether to Issue a permit. I — a <br /> further accept all liability that may be a result of Me County of Burnett relying on this Information I am providing In this <br /> Information I am providing will be relied upon by a c > a a <br /> qo <br /> application. I agree to permit county officialsn charged with time <br /> for <br /> purpose <br /> county ordinances or other authorized person to have n o o N r <br /> access to Me above-described premises a[any reasonable time for Me purpose of Inspection. 8 S .+ <br /> Q J> W Oizi NNw N W n <br /> OWNER'S SIGNATURE (rL./.E_.unyyt, 3 q S a 0 0 0 o y <br /> C a 6 <br /> (date) c no�mn� � = 'z' <br /> go 3 <br /> ZONING ADMINISTRATOR ` )/J") ��/�/��j _:h �. ti c n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ` <br /> •A�Nf9{y f9� <br /> NN O lA lA p <br /> Vi O O O O O <br />