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0 <br /> 3 ) <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning AdministratorFTJ <br /> = <br /> APPLICA ION FOR LAND USE PERMITS = <br /> ( � <br /> OWNER O r 66u/ zq TELEPHONE 2 G <br /> MAILING ADDRESS V <br /> �.0 <br /> PROPERTY ADDRESS O _ . v\/'Cs h51-t�� �✓S . II `\ <br /> LEGAL DESCRIPTION SE SL A3_ 3g/7 <br /> TYPE of PERMIT(S); SINGLE-FAMILY DWELLING,Q ADDITION 0 DECK43 GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMME CIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE❑ - - <br /> Z <br /> STRUCTURE/ADDITION USE: U\W* <br /> (Home/Cabin;Comm-err�ial Buri ; Bedroom; Deck;etc) <br /> BUILDING CONTRACTOR: - " JCr V). 1�"tO ✓� S- -�y�8 <br /> � p <br /> A PLOT PUN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. T R)E <br /> r <br /> DIRECTIONS FOR PLOT PUN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. - <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW n <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). v e a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS) <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEMC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES S. <br /> TO BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. T SJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> PUNS 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. w <br /> THIS PERMIT IS SUB]ER TO ALL CONDITIONS LISTED BELOW: � ;< <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 'j z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'Sl <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. $a <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER `7 <br /> SETBACK AREA. CY <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. S <br /> 6. <br /> 7. <br /> Rn <br /> 2 _ - S j <br /> IdedareMat this ndtelief it is ion true(including rrandcmplete. Iackowlede)M1atbam een exares,onedbyme and r thedtaHeberturaof y 30 ,29 = <br /> knowledgeand itis <br /> application(including <br /> mudinga. y acknowledge MatIule)and I ible fudher Maame thtIll accuragofall <br /> Information mnninm in this application(inOudln9 anY accompanying uM1edule)and[hrther detlare that recggnize Oat this <br /> _ <br /> information I am providing will be relied upon by Me County of Burnett Wisconsin in determining whether to issue a Permit. I _ = <br /> IuttM1er adept all liability Mat may be a result of the Count,of Burnett relying on this information I am providing in"is _ <br /> application. Iagree toperm itmun aMcials charged with administrating county ordinances or other authorized Person to v` o $$ y <br /> have access in the above-dent n remises at any sonable time for Me Du"w of inspection. > 9 <br /> OWNER'S SIGNATURE �— /7 n 85 c <br /> ,f- 1 (date) nom/ Z' n >0 a .^, ate- _, L <br /> ZONING ADMINISTRATOR_��/I(�a _ As -6 Z.A. U//rs / ��_ <br /> TOWNSHIPMAY BE REQUIRED V = - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE y <br /> uu4u ` 00 <br />