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v Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> ° R <br /> v, <br /> OWNERKe _ 1 Ot �S o,-% TELEPHONE <br /> MAILING ADDRE155F'1"1O�J�©Y� Ile fl LY ) = <br /> aam0 11-A (n A] 5S314 �1 , <br /> PROPERTY ADDRESS +7 �2n� gonn� ( k fed <br /> I i^I <br /> G % [7 L �7 L� V0 1 <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING ❑ ADDITIONA DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ a . <br /> STRUCTURE/ADDITION USE: " 1aS6r at'Ar C, I Ii ICS o <br /> (Home/Cabin; <br /> Commercial Business; Bedr om; Deck; etc.)) <br /> Y (Q—) <br /> BUILDING CONTRACTOR: L C../l�er n S �r era 1S-SLP LPZ F7S .. <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 r/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. *f <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r, <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW to v 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). N I z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 (�,1 O <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S� <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. 1 p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES I <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> F. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. V) `o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ( .a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: b r U <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. E <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 �v <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 1L s �0ano nnavro <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my E F <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this v E <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I <br /> further accept all liability that may be a result of the County of Burnett relying on 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 <br /> access to the above-described premises at any reaso le time for the purpose of Inspection. <br /> mAw� Daoocco "d <br /> OWNER'S SIGNATURE /044P J// <br /> C <br /> S °S° xH E n mZONING ADMINISTRATWNSHIP <br /> PERMITS MAY BE REQUIREDOCT $7 ZOIi <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU <br /> 00000 <br /> BURNETT COU ffy <br /> ZONING <br />