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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 ti <br /> 7 C <br /> OWNER GT ran f 'Q L eqn 1T1_Z TELEPHONE -115- 556 - 0034 e <br /> T) o <br /> ��q try ° o <br /> MAILING ADDRESS a� I G pa;ry l a-,d Rd Menomonee WE 6LI /rj 1 l <br /> J 1 <br /> PROPERTY ADDRESS aZ S yl2 Kf �SOa^e TZd Dot1'►bW u (A) 5'18.'0 0 <br /> LEGAL DESCRIPTION S' <br /> Csm�3 �. a 13— ` 0—IS <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLINGADDITION DECK GARAGE/ACCESSORY STRUCTURE 3 <br /> BUNKHOUSE 59.692(1V)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT <br /> COMMERCIAL BUILDINGCOMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE <br /> STRUCTURE/ADDITION USE: ifabfrt. — .Screen Pvrc4'1 *'z. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) —� P <br /> BUILDING CONTRACTOR: (TLLIG Com fie Ken Gale <br /> o � J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o �' <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) vV o <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 to w 03 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N I 1 0 <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 S <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O C> <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. v, <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. }1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: U <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r] z p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. 0,K. l c.� <br /> 7. s � > 0000ao e <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my3 0,°�� o g o g <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all c, m i=. w R a <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this a c, > aN <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I is Fa. — re <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this Fr h 6, <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have '° n 4 "' 8 0 <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. o 8 w w f•: <br /> � ag > <br /> OWNER'S SIGNATUREn� ao �md � 2 <br /> (date) o n HF. <br /> ZONING ADMINISTRATOR <br /> nN. <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> J N O Vp <br /> Vto O O O O O <br />