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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Offic of Zoning Administrator <br /> APPLICATION/FOR LAND USE PER ITS ? tn) <br /> OWNER A-) TELEPHONE � _ 8N-�Y <br /> MAILING ADDRESS a <br /> QUuv <br /> PROPERTY ADDRESS G,// /' 2 E E N moi— �G TG <br /> LEGAL DESCRIPTION S O S' v <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING$g ADDITION O DECK ❑ GARAG ACCESSORY STRUCTURE ❑ rn <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL AC ESSORY STRUCTURE ❑ S' <br /> STRUCTURE/ADDITION USE: O M c— A- ' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) I <br /> BUILDING CONTRACTOR: -Fre' <br /> VJ�` <br /> C rn C� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2 X11 SHEET OF PAPER. ANY INCOMPLET <br /> WILL BE RETURNED. OR ILLEGIBLE PLOT PLANS C o �C <br /> /.' I- <br /> tJ/ Cm <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) l.'�' a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TOS LE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW t`i1 v o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER S RUCTURES, B <br /> AND INDICATE NORTH (N). "y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) S`J <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DI ENSIONS. C d <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIEL (DF), AND ALL DISTANCES a p Cj <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 3. y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE DED OR FILLED. .. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDE , CONTRACTOR, ETC.,THE 7n <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. " py' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI ON MY BE DONE WHEN <br /> NEEDED. I—I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS F PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG F PERMIT. <br /> n z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFI ILLY PERMITTED. Z <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN T E REQUIRED WATER I� O <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDEN L GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6• �Q-E�J2c.k verieat >'75� �-/�1-OBJ� F <br /> 7. � .. c c cmc t� <br /> n <br /> I declare that this application(Including any accompanying schedule)has been examined 8 3 3 S o <br /> by me a to l a best of my <br /> knowledge and belief tt Is true,correct and complete. I acknowledge that I am responsible for the etail and accuracy of all <br /> information contained In this application(including any accompanying schedule)and I further declai a that I recognize that this �E. a a to <br /> Information I am providing will be relied upon by the County of Bumett Wisconsin In determining w ether to Issue a permit. I <br /> further accept all liability that may be a result of Me County of Sumett relying on this Information I 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 reasonable time for the purpose of Inspection, <br /> OWNER'S SIGNATURE <br /> a -.m <br /> --�; _ (date) <br /> ZONING ADMINISTRATOR ✓i rYi t716C fl L a,—, y a' g ce, 41 <br /> n Qtr1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS UANCE CH N H M <br /> O�nki-P1letke- cf�ev[ .fv &v,v�y /�uh � - aic,-6) � � s000s <br />