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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g G ° <br /> APPLICATION FOR LAND USE PERMITS <br /> s� A _n Ef FCEA <br /> OWNER jAf,RV L (`/ �K (TRIASr ELEPHONE92o -337-62� = o�� <br /> h V I _ <br /> MAILING ADDRESS i7©S S , C C A,P S,i� .7�C pE/L E Gly/ Sys/ <br /> PROPERTY ADDRESS '� Jr <br /> Go4 "rY R7) U -pAujAQ1Zy. rte/ Ti <br /> `h <br /> LEGAL DESCRIPTION c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION O DECK 0 GARAGE/ACCESSORY STRUCTURE X .. <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT❑ <br /> COMMERCIAL BUILDING 0 ^^COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE: b AQ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: WILL G p YSeL � <br /> J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 �h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) rni c <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 <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) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w W <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES I q <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. OJJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> fO <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. C? n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. DI <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 11 <br /> SETBACK AREA. — ry J <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Q) <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. & <br /> -- gya �agng �� a ro <br /> 7. <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 detall and accuracy of all c to <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this v E.a a m N <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 ^ m.°� o g o r" <br /> access to Me above-described premises at any reasonable time <br /> forUpurpoof Inspection. m W3 � Sa0000g � <br /> OWNER'S SIGNATU A c g to <br /> w m O <br /> n a a: <br /> Jr /^ I (date) Oil <br /> $ ` v <br /> ZONING ADMINISTRATOR 1 rEt <br /> mow' o� ts1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 5 <br /> THIS <br /> �] PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE " <br /> 12 r tot ?-rcw u r Ly <br />