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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS : T <br /> C n <br /> OWNER LI l�y FJ N 6 ✓��I l✓�' ✓I k ✓TELEPHONE G qqa`� a `� <br /> MAILING ADDRESS/ u/ p K�TTLe /\ IIJe/� 34/� few7i sM <br /> O n � � R <br /> PROPERTY ADDRESS Q/ ^ ry 0&M)q / /J/f ���/ U�y /.'/• I G� <br /> LEGAL DESCRIPTION <br /> L aT 25 n N`'2 506' '/4 .�./g, 7_004 R J60 K <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING �ON ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT 0 <br /> v <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o <br /> STRUCTURE/ADDITION USE: 40Jil��lS 3G Ahf4 FwE <br /> (Home/Cabin; Comme .al Business; Bedroom; Deck; etc.) I r V <br /> BUILDING CONTRACTOR: U o 7 °G7104/ � <br /> Je wt <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT UNS <br /> WILL BE RETURNED. N <br /> J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARiAL OR TOP VIEW) Inn a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <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, v v <br /> AND INDICATE NORTH (N). N c <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 v <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. d <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES n 6` <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m c' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 7t W d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. yR; <br /> trh <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r Q 2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <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. h o <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O 6a <br /> SETBACK AREA. (N p <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 8 C <br /> NOT TO BE USED FOR HUMAN HABITATION. d <br /> 6. .axe Cead�F9oe ffT'rlc(+c,(. <br /> 7. x � > a <br /> 000nro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my B o ,Z <br /> knowledge and belief It is true,correct and compete. I adinowledge that I am responsible for the detail and accuracy at all o. w"=!u. <br /> Information contained in this application(including any accompanying sdhedule)and I further decant that I recognize that this .o c. > a m <br /> N <br /> Information I am providing coal be relied upon by the County d Burnett Wisconsin in determining whether to issre a permit. I .e 5 R ? w'V <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing M this c w b,» '_^N b <br /> application. I agree to permit mwRy officials charged with adminl4rating county ordinances or other authorized person to have o LI 8 c 8 88 <br /> access to the above-described premises at any reasonable tkne for thed i <br /> � nSa8So �8y <br /> OWNER'S SIGNATURE ` 7, <br /> � 2: <br /> A (date) c <br /> ZONING ADMINISTRATOR ft56� 7A <br /> W <br /> T NSHIP PtRMrrS MAY BE REQUIRED A <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N N <br /> � �, 80008 <br />