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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS a (� <br /> OWNER Rl n ' / I„ r ,JTELEPHONE -jlij_/ -3-(4"7-33 <br /> MAILING ADDRESS r1��`�+� Bzln6) 1 Lct QI ke � 1 Ubad r 5, l8c)l <br /> 7 `/ J � o <br /> PROPERTY ADDRESS <br /> J — <br /> LEGAL DESCRIPTIO \ w {> <br /> L,E o x4 4S rl tT- <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: <br /> 3-hedr0c)rn ID{ Yl� z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> qj <br /> BUILDING CONTRACTOR: N01TIROJEW AAA Oidk dors ILLG <br /> 6 <br /> h) Z36H BIGruSarl 6L✓D ., 7e cc. w� 54888 7i�13�—,7,19q <br /> A PLOT PLAN MUST BE PROVIDE OD N AN 8'+h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS v <br /> WILL BE RETURNED. 3 �W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c c ¢ <br /> 6 � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O 3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW1,, <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 'a z <br /> AND INDICATE NORTH (N). p� <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 C) 3 B <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N �, <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES �. -S� o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 9. l <br /> i1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> Ui <br /> THIS PERMIT IS SUB]ECi TO ALL CONDITIONS LISTED BELOW: � <br /> P <br /> r z <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. n O( <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !n <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. On Au)tlli,j pz,r pardI • tXl5firL h0rv.e be �evnovPa! Wi+hu-� l yCar ccFae� <br /> nevo home consfracfi'o,� j5 cdmple�+e- <br /> 7. y3 ° Fna t+7 <br /> 7 0 .0.y ow <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge Z�, <br /> and belief It Is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of all information o <br /> contained In this application(Including any accompanying schedule)and I further declare that 1 recognize that this information I <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all ((ry((/X����°0000 <br /> liability that may be a result of the County of Burnett relying onthisInformation I am providing In this application. I agree to v l <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- v <br /> described premises at any reasonable time for the purpose of Inspection. (-"� p m= = y <br /> OWNER'S SIGNATURE �rL'w"' /j Ia�.r A <br /> VVVV --�� y,,^//J,�1 n T(d�ath) s+ a _ <br /> ZONING ADMINISTRATOR �J'O / !L(r (((^d r) N w 117 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> cN o � � o <br /> 4 le ��er �lc�ed �� by Riet alder /l- a8� <br />