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fn 9 Z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator < v i <br /> APPLICATION FOR LAND USE PERMITS c� <br /> OWNER Mi�hA�L - .Tanie� TELEPHONE a <br /> Flerer <br /> MAILING ADDRESS <br /> oZ7oZ,41 `JTCA)e- R.d. web E;k-►- WT, 58'93 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION (iNf _SW SW �gECTId N JS- 7-40N R!(oW Q()QNe#'-- etl. u1T5, <br /> n <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECKX GARAGE/ACCESSORY STRUCTURE❑ � <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ p <br /> s T <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCRIRE ❑ <br /> STRUCTURE/ADDITION USE: IX 7C 14' IJE--K z <br /> o <br /> ����`` ome m; Ommeraa usiness; room; ec ;et.) <br /> BUILDING CONTRACTOR: /To'y'ff ou_) er N <br /> O S <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) MC O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. av <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW M c <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J <br /> AND INDICATE NORTH(N). o <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 Q <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES A) <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 0� v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. qJ r U <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: FQh Q, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. _ O <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER I Q <br /> SETBACK AREA. rA ) <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. G <br /> 6. <br /> 7. oannnna0 �d <br /> 72 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my o ,Z n ? oe 4 <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 n y <br /> Information I am providing will be relied u o. R a <br /> p g upon by the County of Burnett Wisconsin in determining whether to issue a permit. I G . r a �' <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this m= -�- <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to C: c o n -V <br /> have access to the above-described premises t any rea able a for the pu a of inspection. p E; w ti W n <br /> OWNER'S SIGNATURE <br /> (date) n <br /> ZONING ADMINISTRATOR ' o x rc rsy <br /> 2 L C <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o . <br /> p. yI f-I�,occ� ro J(nl c�ael 1-fc( er- 9_( <br /> uu So\`po <br /> r <br />