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z <br /> Burnett County 74 0 County Roatl K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLIC h FOR LAND USE PERMITS s <br /> OWNER TELEPHONE /„ m^ LNIAp <br /> MAILING ADDRESS g96'0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION j U� II � rS n1 /1I� . 111 - �Ga J/Tyou'�ly <br /> Tuve Or veaHlT(5): <br /> SINGLE DWELLING ❑ AD Ifi ❑ DECK❑ GARAGEJACCESSORY STRUCTURE❑ <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS FILLING/GRADING 0 CAMPING UNIT O - <br /> COMMERCIAL BUILDING O COMMERCIAL ADD ON 0 C�O�M��MEER/sIIAAtL,ACC/ESSO/R'Y STRUCTURE O 3_ <br /> STRUCTURE/ADDITION USE: 1���/�� ��t//l.l A/ f-,�KG�fL O 2U� I-z3 <br /> pme bm;Qbmmercial Business; Bedroom; k; etc.) <br /> `_I r, <br /> BUILDING CONTRACTOR:5d _ <br /> This Ierl%� -Fo� � JUC� S�u'!b x _ <br /> A PLOT N MUST BE PROVIDED ON AN 8'A X11 SHEET OF PAPER. A INCOMPLETE OR ILLEdIBLE PLOT GLANS r <br /> WILL BE RETURNED. <br /> m O <br /> DIRELTION5 FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) _ <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 <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). _ Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) oo <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEAS IREMENT(S)TO THE ORDINARY HIGH WATER MARK NN o <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. n <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES r <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC,THE -�. UI s V z, <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I V 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: VQ) F C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. IL <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER L <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TOnBE_USED <br /> FOR HUMAN <br /> �HABITATION. <br /> 6. -01S �Ofrry I4r), ere Lw i Otexe� S�4JLr - <br /> ]. �QyU.I-C'-mP <br /> n33 di <br /> I declare that this application(including any accompanying schedule)"a been examined by the and to the best of my <br /> knowledge aM belief it is We,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 l further declare that l recognize that this =o ao_ " <br /> Information I am Providing will be relied upon by the County of Bumett Wisconsin in determining whether to issue a Permit I _ = <br /> further accept all liability Mat may he a result of the County of Burnett relying on this information l am Providing in this <br /> application. I agree M permit coun Gals charggdw hadministrating county ordinances or other authorized permnN <br /> have access to Me dbove-deSCH�ires ata /�a nable time lor Ne Purpose of inspection.. ? ii > i <br /> OWNER'SSIGNATURE ]/-;2P-l3 _ : 6 ; 5 <br /> (data) w >? <br /> ZONING ADMINISTRATOR gp� 4 F <br /> Ll,' ac ' aa : <br /> TOWNSHIP PERMITS MAY BE REQUIRED '- s <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE R r <br /> e 5 <br /> Nub <br />