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ON COMPUTER/ CANNED Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator 3 a1 <br /> LlAPPLICATION FOR LAND USE PERMITS 1 N <br /> OWNER (�' Q'J\J�IC V71 VL��. TC7EI�aNbO� l�fJ <br /> m <br /> MAILING ADDRSS/C"//U t tna S-7- &5� kIv <br /> sIre� , gra <br /> PROPERTY ADDRESS Z("J-7I D I/- C`_ l „ <br /> IJ / 1 I� `+?; I'K.YIDDD��� WWW <br /> LEGAL DESCRIPTION o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING C ADDITION C DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ �1 <br /> BUNKHOUSE C 59.692(1V)GAZEBO C STAIRS 11C FILLING/GRADING C CAMPING UNIT ❑ W <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITIONc❑ COMMERCIAL ACCESSORY STRUCTURE F1 <br /> STRUCTURE/ADDITION USE: --1-i � ro(/L✓1QV7A o--S o <br /> (Home/Cabin; CorhFfiercial Business; Bedroom; Dek <br /> f\,�; etc.) r <br /> BUILDING CONTRACTOR: S�t rJ L-A Vt rhe� r,oLj S L n \� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. N <br /> `n a <br /> DIRECTIONS 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 ern0 0 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, U y a <br /> AND INDICATE NORTH (N). ;� o <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 ,a <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. 1 p OO <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 1 g <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> t 1 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. 1 T' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> U <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. , n C> C? <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. x <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 <br /> SETBACK AREA. W <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. £ <br /> 6 DK fb u (D0 <br /> 6 = 7f <br /> xzoya3g. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my3 0 ,� B ° <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all cm <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this .o = D D m „c, Y <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 3 2 d = ,o <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this �� c s4 v+ w 69 'd <br /> application. I agree to permit countycials char d with administrating county ordinances or other authorized person to have <br /> access to the above-described preml at any rea na time for the purpose of Inspection. Y <br /> m '+1 a � oo oo ` <br /> OWNER'S SIGNATURE bq / a D= m nK T O <br /> y� (dateo c o O <br /> � I1 I <br /> ZONING ADMINISTRATOR an <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0' w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />