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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER ., I <br /> TELEPHONE <br /> c <br /> fd1J TVI f5eV1 7/S-zsCl -3183_ ° o0 <br /> MAILING ADDRESS 2� 93 13D--" <br /> PROPERTY ADDRESS -U Yl/J.i 7 (J�V it n 1 <br /> 2� 493 136nn Z d Ke17 <br /> d o <br /> LEGAL DESCRIPTIONi <br /> a-,rri ov' Aes$eSo.r S jV'i. ° Frnve <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ ,or, <br /> TYPE OF PERMIT(S): lll��o b <br /> FILLING/GRADING ❑S CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO 11 DECK ❑ <br /> STRUCTURE/ADDITION USE: I�+OMd <br /> Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: 10 Q c + N. 1')ezx f Ul faa r - r <br /> Rea 44 ae+ Oo„ V�,�c1Bv 4e-k. • 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> WILL BE RETURNED. O <br /> X <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a 2. <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnn O <br /> 2. SHOV!THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND.ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, t'f <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o <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 DIMENSIONS. N h <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES -°�. o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. a'a <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 S <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. R 1 <br /> U <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. C J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> z C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' �f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <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. N Q <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> — > > 9 <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge w C <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information o °' <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this information I <br /> am providingwill be relied upon b the Countyof Burnett Wisconsin In determiningwhether to Issue a permit. I further accept all R <br /> liability that a be a result of the County of Burnett relying on this Information I am providing M this application. I agree to ^'o `^ `J" c tom" <br /> ry Y ty Y 9 P 9 Pp 9 4�`" <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o °: n <br /> described Premises at any reasonable time for the purpose of inspection. / O T m y <br /> OWNER'S SIGNATURE <br /> v y� (d te) th °—�, > em w t.+9 <br /> ZONING ADMINISTRATOR 11 J �/A I /((/Vii/ V J: J �° 7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED (TJ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v <br /> Peim(+ 4 lir rn,Uled 4-o RK-An/dr'n f '/�✓seg R-IS-D�t <br />