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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS <br /> y <br /> OWNER TELEPHONE c <br /> c �1� smS{ora�t„> f3" -7I5 - 684 -�a4Li o <br /> MAILING ADDRESS +A— <br /> �q H X130 <br /> PROPERTY ADDRESS w <br /> 3949 W-Qjj Over Lake Rif Oct, lIn t ,I Syc336 J <br /> �r� NUJ � C� <br /> LEGAL DESCRIPTIf SeGov Lef 3Oc 1 0?� ToT S s-s 1.4 r 9 <br /> RE ❑ ADDITION 5SINGLE FAMILY DWELLING ❑ GARAGE/ACE ORVTRU 5g � <br /> J <br /> 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: w+.f >{o (-., k e f.r• eg 6 •n z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: Van« anA! 00r'fc( Co nall . A,,. <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS sy (p <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <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 m K <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK J R <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. v, Z <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. w <br /> 5. 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 q <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> ti I <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: V' <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 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. to <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER � O' <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. 5kie-j -IV h (IonSJrftefed on PO5fs On I -CorYF,roled oto nor <br /> f! 3o'G7 a�moaoro <br /> 7. ^ m ma as <br /> n'Fa `° <br /> 3 9 w c y w <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 2r <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o r-v r] <br /> described premises at any reasonable time for the purpose of Inspection. .w, C y a '_' y <br /> C o <br /> ar <br /> OWNER'S SIGNATURE 1 b-Wa' 1 f 00 - 0 7 o A a z <br /> In (date) <br /> ZONING ADMINISTRATOR �J'rn <br /> �l l�l,n l•�yi/'� ^^—� 3'6 m �' <br /> ' <br /> c V <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE V O w w <br /> Pe,( 4 f'led 4v Jbhn n`vil- k <br />