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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS " <br /> OWNER Tmes N Tohnsfw Geoffr4 Al. U-hes+e,uTELEPHONE -7)S-Z65 µ2Z1 a ^` <br /> v <br /> y Ir< <br /> MAILING ADDRESS p0 Bqt. Lb? Pi wo Fans WI SY'7b0 N <br /> PROPERTY ADDRESS <br /> 22539 U-1 Ric /I <br /> LEGAL DESCRIPTION 533 T aN K"tW C$H J4' P 251, (/N IVe <br /> SINGLE FAMILY DWELLING M GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ o j <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) �y <br /> I <br /> BUILDING CONTRACTOR: _LorrVTi QuaLJ++�fPndrartl 97 'ySIA St. _Fr e4 L[i.L�h037 ---- <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> 3 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r <br /> � c <br /> r. <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 " < <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, rm <br /> AND INDICATE NORTH (N). <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 .� <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. o ✓ z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE C/J <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I <br /> a <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: (6 <br /> v z � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ry z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y v`I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. t7 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER N <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TOB USED FOR HUMAN HABITATION. <br /> � <br /> 6. S L- re �f J9U� o t Cc/J9'1I9[i /v /N' _ — ;7 a m c a o M <br /> ra m <br /> I declare that this app(ifatlon(I lulling any accompanyll schedW has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information a o 2 <br /> contained in this application (Including any accompanying schedule)and I further declare that I recognize that this information I e, <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the County of Burnett relying on this information I am providing In this application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- ri <br /> described premises at any reasonable time for the p ose of insl�ectlon. m a a o <br /> m <br /> OWNER'S SIGNATURE 2�7/ZOCg o n N <br /> rt D <br /> (date) 3 a ° <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' ^ ' <br /> N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> arm`, le I mai Ind 7whes7Zlh�svh -3�8 <br />