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v - Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER <br /> ecl6l �A- TELEPHONE q1 <br /> (J �1'lypm �� 15- 557-06 /'!> <br /> MAILING ADDRESS ^ s0 <br /> .4/1 5Yo <br /> PROPERTY ADDRESSn =' S <br /> 1 3e �f. /l ✓L d, J'p0C"eI�. <br /> LEGAL DESCRIPTION Piz- <br /> LoT 2- , CSM U �L- , f21) Ih G-Y ✓ Lor <br /> TYPE OF PERMMS): SINGLE-FAMILY DWELLING O ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ � 97yJ <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 — <br /> z <br /> STRUCNRE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> F <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/x X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 <br /> WILL BE RETURNED. T <br /> r <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (AREAL 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 O <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 1 <br /> AND INDICATE NORTH(N). O o ?_I > <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) - <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S p <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS, Su IIJ <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES -G <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. -C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q_I 5 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE 1"nl <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. ( / - C <br /> vl 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN Lill,, <br /> C� O <br /> NEEDED. ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. CS <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 !r� <br /> SETBACK AREA. f T <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGUSTORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. _ <br /> 6. <br /> 7. <br /> R n 3 3 = Z <br /> I declare that this application(including any accompanying schedule)has been examined by 3 3 3 <br /> knowleUgeand belief iiishue,mrrectand complete. 1 acknowledge <br /> cluding any compayin Oat <br /> eulresponsible er Meare thandeconCe of all _ _ y <br /> information I am <br /> in providing <br /> be <br /> stion eliedu upon <br /> Count'of Burleg Wisconsin <br /> in e)and <br /> determining <br /> declare that issue recognize MatI _ _c i <br /> further acnlam provitling Willa bea result <br /> of he County of Burnett Wiug oin in information <br /> w amprvi issuepermit. l _ _ <br /> further accept all liability that maybesresult ofare County of Burnett relying on Midinformationler provitling in this m 'q <br /> have <br /> eaccess lagree toe-dacccounryornism, charged wimatlministorthecounty artlfinpecti other authorized person O n <br /> M1ave arcessm Meabbve4esuibe premiseslIa[//a//y reasonablelltpime for me purpose of inzp/e'cfion. > i YN _ � r'] <br /> OWNER'S SIGNATURE ♦/W ` /0 -Z?, ❑ <br /> ll EF <br /> = � <br /> ZONING ADMINISTRATOR - <br /> _e T <br /> OCT 242013 w5 <br /> TOWNSHIP PERMITS MAY BE REQUIRED = - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN s <br /> BURNETT COU - <br /> ZONING u s '8 o s <br />