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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administratora ( 3 z <br /> 1 APPLICATION FOR LAND USE PERMITS : <br /> J t t wK- 952-- 8sH- �1�`101, <br /> OWNER 6 <br /> TELEPHONE <br /> MAILING ADDRESS <br /> rMu s WI %Oe v <br /> I � <br /> PROPERTY ADDRESS J nom- <br /> 590 <br /> yL14T�j1.kYhl 2�C�rYi <br /> LEGAL DESCRIPTION Jw �4't " � t/[k• �c, t <br /> 2�/ 1 36 <br /> TYPE OF PERMIT(S): SINGL FA ILY OW&LING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ v, <br /> BUNKHOUSE 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ � <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION 11 COMMERCIAL ACCESSORY STRUCTURE 11o <br /> STRUCTURE/ADDITION USE: / <446, - fes' / () <br /> (H , Jkehtc,.�; c f z <br /> p <br /> BUILDING CONTRACTOR: . <br /> n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN B 1/2X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. O <br /> � e <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. G my <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ,+�1 v '� o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, q .a <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 o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK i <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. 1 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES RJ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - N <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. wp P. yj <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC. O,THE -L <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. -C �("� , 0 UJ <br /> W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ,.a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p <br /> it <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. GI A <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. r-� <br /> NOT TO BE USED FOR HUMAN HABITATION. V <br /> 6. <br /> 7. 'D o 0 0 <br /> � 'B � El <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all _- <br /> El <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this ,p to <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I E D a m> n w Y <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this t w ^d <br /> _ 1.l ro <br /> access tiot I agree cl permR co ofFldals charged with administrating county ordinances or other authorized person[o have q ' o o t" <br /> access to the above-described p ses at any reasonable time for a purpose of Inspection. p o d `� o 0 0 0 ,.,., <br /> w n <br /> OWNER'S SIGNATURE <br /> (date) o G 2 <br /> F C F y <br /> ZONING ADMINISTRAT y g n <br /> mac ' xam <br /> m o n <br /> OWNSHIP PERS MAY BE REQUIRED - <br /> THIS PE IT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ti <br />