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Burnett County 7410 County Road K, No. 102, Siren, WI 54672 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> y U) <br /> o � <br /> OWNER TELEPHONEq,-d_ X38 _ <br /> e a <br /> a <br /> MAILING ADDRESS ?96s <br /> 1 � <br /> z� <br /> PROPERTY ADDRESS ��1/ '�� n I I�� _1 A Itl�t�t 1 i <br /> �/ �*-RR IilJw , VViI04 t11 <br /> LEGAL DESCRIPTION <br /> [-Vis, pe_ �Ck` . 1 jDw'ti\$�)P qO <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION!" DECK ❑ GARAGE/ACCESSORY STRUCT RE y <br /> 713 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COIMMERCIAL ACCESSORY STRUCTURE ❑ .°r. � A (D <br /> STRUCTURE/ADDITION USE: .tk, C'ts �' J <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: e*- <br /> w�, <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C I m <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, G 1 a <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) J J <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. ty <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 9J <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE U o 'h <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. ` — '� 5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o- r., cC ^; <br /> (Crl O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. oz <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. U '� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER C, <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. o <br /> NOT TO BE USED FOR HUMAN HABITATION. G <br /> 6. G f <br /> 7. T � > r o o nc 'd <br /> R � R33 � �v o:^ CL1 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my p P S � w' <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all c m 'm_' d <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that[his a 5. a > w N !, <br /> Information I am providing will be relied upon by the County of umett Wisconsin In determining whether to Issue a permit. I a a = <br /> further accept all liability that may be a revel of the County umett relying on this Information I am providing In this <br /> application. I agree to perm@ coyn o cl charged wtth dminlstrating county ordinances or other authorized person to haveO,� 8 g <br /> access to the above-described preml s ny rea time for the purpose of Inspection. c � a F ti W n <br /> OWNER'S SIGNATUR <br /> zga . ton ym0 <br /> (date) <br /> ZONING ADMINISTRATOR V t{m �Iw d((/,�(n,,Il <br /> TOWNSHIP PERMITS MAY BE REQUIRED A G b9 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE H N« H <br /> pj(nC-+ (e+4erpicke( by bL, idhr) ' I-ruv)kq-I6-ii o og <br />