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fi b <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P �N <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER <br /> /Yl /T(/yCTELEPHONE <br /> LC /� � IZid� 15 J <br /> MAILING ADDRESS / �QC, �� tL '4V Al <br /> PROPERTY ADDRESS t'�� rl OC.) �'If <br /> C �7 b C,G /Y�L f J d✓ k <br /> < <br /> LEGAL DESCRIPTION ZOT/ S-N T-VI/q A -/SA) W i/t S6 tmo <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 f <br /> a <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 r '+ <br /> STRUCTURE/ADDITION USE: ° 1 f-fl&N 04Q1N S70IZA6 E Z <br /> o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ITC FC( /YI/L/ <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 �h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o '— <br /> WILL BE RETURNED. a14 <br /> (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C K <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, R <br /> AND INDICATE NORTH (N). N 911 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ,°� 4J <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w5 w <br /> F <br /> 4. SHOW THE L CATIONROF THE WELL DO <br /> (W)SEPTIC TANK(ST)ANDDRAINE <br /> F DD (DF),AND ALL DISTANCES U <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. v, <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I �+ L —L <br /> o <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: Y' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y d <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 0' <br /> SETBACK AREA. W <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. d <br /> 7. s ;0 90 0 0ny 9t7b <br /> rt to � n t+1 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my3 0,2 B 9 ? w' <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all E. p,='w EL a y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that 1 recognize that this o E.D D m 'O <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I <br /> further accept all liability that may be a result of County of Burnett retying on this Information[am providing In this <br /> application. I agree to permit county ofnclals ch ed with inistrating county ordinances or other authorized person to have <br /> access to the above-described premise an sonab I e for the purpose of Inspection. a o 0 0 $ o <br /> �f. m m yn iyi <br /> OWNER'S SIGNATURE <br /> 07M&( ) c w 6a.o W n O e _ 0 <br /> r <br /> ZONING ADMINISTRATOR <br /> 5 <br /> TOWNSHIP PERMITS MAY BE REQUIRED Q °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE M <br /> PU(Yfj ec011k4-a1/ /hI?Le.✓ 7 D� � Us0000 <br />