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ON COMPUTER/ CANN D z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS H <br /> OWNER �I TELEPHONE 3 / a <br /> 4,,-t— �' — �W <br /> MAILING ADDRESS <br /> _20S— 35- <br /> o,,K,-_ F►Yre . 6'�,�L,a�� IYIN ST-37 2— <br /> PROPERTY ADDRESS <br /> La _ J 0 <br /> l�o Lean <br /> LEGAL DESCRIPTION <br /> cF i/ tT'-/ 60, C_af-2 r' t <br /> See. ay Tyo/1/RlL{GcJ (v <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING qr ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> a <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ � <br /> 0 <br /> STRUCTURE/ADDITION USE: 40M e-- o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> c <br /> c s w- C/) <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. '^ <br /> a <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m �y <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, o <br /> AND INDICATE NORTH (N). tv t a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w5 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. t7 <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. <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. ,C� 7,% '1v� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN li <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: a Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n .z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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 Yl 1 <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. a ;; ; naoro <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 detail and accuracy of all c, to w E <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .a ` D 9 m <br /> Information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I 5 5 ? v - ro <br /> further accept all liability that may be a result of the County of Burnett relying an this Information I am providing In this ; <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have n w o 0 0 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. m w a o w „ o o y <br /> �'q � a000 ooy <br /> OWNER'S SIGNATURE M0 (6tfa�y-' �-E�t <br /> (date) .$6 S E <br /> ZONING ADMINISTRATOR jt� F`W 1 t�4`1 g <br /> P a m <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N ti o N N o <br /> ��✓/h6� 12f4?rrnalteCl -loTc'eY-8 00000 <br />