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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a } <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERNOni LS.1-762-4feyL a <br /> 1/FOM/4S 1,UAI D TELEPHONE�A81WysS-866-81I2 c UI <br /> MAILING ADDRESS ' 'Z 3 N N O LL y AVE No OA KDA L£ Al M9 • -S I28 I ^ O <br /> 1 <br /> PROPERTY ADDRESS S23 <br /> 872- 1 cTY. L <br /> LEGAL DESCRIPTION ('fir eZ' I PR RT OF GOUT . I-0T3 J 5IGYlOr4 2S ) <br /> TaWN6H)oNO RAw6E i7 W TOWN OP UW1QA( ° <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION C DECK C GARAGE/ACCESSORY STRUCTURE E J <br /> BUNKHOUSEC] 59.692(1V)GAZEBO C STAIRS C FILLING/GRADING C CAMPING UNIT C <br /> COMMERCIAL BUILDING C COMMERCIAL ADDITION C COMMERCIAL ACCESSORY STRUCTURE O <br /> STRUCTURE/ADDITION USE: CA13i W h z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) III'1LJ' <br /> BUILDING CONTRACTOR: ®W N E W <br /> n O� <br /> N L <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS l� <br /> xo N 1 <br /> WILL BE RETURNED. 0 — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r'• u <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 on 'a 0 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) SUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5 CEJ <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. C W <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. <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. <br /> Ji <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: — <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, [7 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a <br /> 4.._ NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. "IN <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. � <br /> Ko a <br /> . �I1S1 — doVf <br /> 7nn � <br /> � �d nave <br /> no 3 3 3 a <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 a 5 <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of all <br /> Information contained In this application(Including any accompanying schedule)and 1 further declare that I recognize that this D a m`O <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d a - Y <br /> further accept all liability that may be a result of the County of Burnett retying 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 <br /> access to the above-described premises at any�masonable=time <br /> rpose of Inspection. <br /> W ert `i avluRN <br /> OWNER'S SIGNATURE n �.$ <br /> </�6D o " > oWdp6� z <br /> (date) <br /> ZONING ADMINISTRATORy II�I'1 �)G��Y�I 37 �N w o p <br /> TOWNSHIP PERMITS MAY BE REQUIRED n n °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v.H w <br /> �� 80008 <br />