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R <br /> { <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS H <br /> OWNER/�i,1ovjG kvv LrS,, Aw\LA✓ti TELEPHONE bsi'Nr6-5835 o <br /> MAILING ADDRESS (02.$ ("14t 1, j "?)Lwj LuyAh MMI g123 <br /> m = <br /> PROPERTY ADDRESS Sg (O �j4fo ' Lj <br /> y o Q O <br /> LEGAL DESCRIPTION Y S W y S'6 4 54c. 2y 139 N P, 16 W <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING D ADDITION D DECK D GARAGE/ACCESSORY STRUCTURE m <br /> r <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> v C/' <br /> COMMERCIAL BUILDING D COMMERCIAL ADDITIOON D COMMERCIAL ACCESSORY STRUCTURED b 3 <br /> STRUCTURE/ADDITION USE: Q(CcsjorV llwnt�t, z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cid <br /> BUILDING CONTRACTOR: ._ <br /> O � p <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) [nl <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. w <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 <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) a P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES J <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. H <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p w <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE yJ o v <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 ..i <br /> NEEDED. (�(In� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Vw ` <br /> � � O <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. <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 I <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. <br /> 7. ^z 'A yo 0 0 [: Da07 <br /> m n 3 nn rn <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 c m d r d a <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this a D D m e <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 d a $w ,ay <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. 1 agree to permit county officials charged with administrating county ordinances or other authorized person to have a d <br /> access to the above-described premises at any reasonable time for the purpose of inspection. °m o'uo1g, W W N w (•7 <br /> OWNER'S SIGNATURE <br /> ry y <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> � � s0000 <br /> ��m��-� ►���mcz�Ind to rhon-fie fh�rlunc�,s-�,-o5' <br />