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b 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 /> OWNER TELEPHONE r <br /> b91- 790-39 0y - foo` d- SJ <br /> a <br /> '4- Lav�ck Warrk'_L (p12-7`1y'96 2 f Gc \1 d <br /> MAILING ADDRESS .� J/ v O <br /> __.-- dW3 Faso Fano Cor. A✓ /oresLaf e. ZW S:S _0,2 S- <br /> PROPERTY ADDRESS ^ <br /> dY8/9 � 5 . Jonson � k 120 �✓��S�cr �t/1 S'��93 <br /> LEGAL DESCRIPTIONo <br /> PGL 60V L64CLots 3�¢33J o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE ❑ .. <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL DDITION 11 COMMERCIAL ACCESSORY STRUCTURE 11o <br /> l <br /> STRUCTURE/ADDITION USE: //OM c�CCr 20 )>j 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> n�J <br /> BUILDING CONTRACTOR: JJit lI h PV I To /-6 C, n <br /> N <br /> G < SUr <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS p o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) V <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 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ° I n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK B V I <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 11 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <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. ) w 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r �. <br /> Dq <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. c� Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B p <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. 0 303 D o m a0 7 <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 /> information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this `: D D <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I .� c c w= '. .ap <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this c '" «,w d'N C <br /> application. I agree to permit cou officials Sparged with nistrating county ordinances or other authorized person to have <br /> access to the above-described pr ises at reasonabjetime fop1he purpose of Inspection. c w�4 cx n <br /> m <br /> % Ei ao 000 � y <br /> OWNER'S SIGNATUR 0 y L' <br /> `�t11—� `f�� /y✓7 (date) 0 $ 3 <br /> ZONING ADM STRAT I(Y1 y <br /> _ � 3 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti o N N N o <br /> 000 � o <br />