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is� � <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' W <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERC <br /> TELEPHONE r� �)LLLLI'Z11 �e 1[5 \e n' S' `I <br /> MAILING ADDRESS <br /> /� <br /> PROPERTY ADDRESSV/LL W-T .5q V <br /> �ll�0 /'Y)al. ne fid . lt/ebs fe r <br /> LEGAL DESCRIPTION PZc) ooI7- 018-�2 -39 -Ib- 19 -0, 0a -000 -() 0-000 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION DECK kAG ACCESSORY$TR �. <br /> BUNKHOUSE• 59.692(IV)GAZEBO STAIRS FILUNG/GRADING CAMPING UNIT t Q <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE <br /> STRUCTURE/ADDITION USE: <br /> e (Home/Cabin;Commer0al Business; Bedroom; Delle;etc.) 1 <br /> BUILDING CONTRACTOR: <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> n a <br /> DIRECTIONS FOR PLOT PUN DRAWING: (AWAL OR TOP VIEW) v <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, V N v <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(5) cl� L•. I <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETIAND AREAS,AND(D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <br /> v _ <br /> S. INDICATE IFA WALKOUT BASEMENT IS MANNED AND SHOW AREATO BE GRADED FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,,BUILDER,CONTRACTOR,ETC.,THE y45 <br /> MANS 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. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ��cYYYIII T <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, i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> —4.— NO STRUCTURES,-INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 9J <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY, <br /> NOT TO BE USED FOR HUMAN HABITATION I I F <br /> 6. STUrPr &(J 1D &e 7 /U�f" Vi--m for -ii-l�l <br /> 7 � ADnn nC�D � y <br /> � ^ 333 � dn � <br /> Idedae that this appgcaBon(CWuding arty aasmWmir9sNMule)has been examinW by me aha to the best M my <br /> krwwkdpe aha pellet i[is true,wrrect aha mmpkm. I ac n owledge th I am re bk w me detail aha ara ()tall <br /> In formation mntamed in this application(inducting any amom,anYing schedule)aha l further dada()that[remgnhm that this Q Doa$ Y <br /> 'nfmmatlon[am pmvidlrq will D<relied upon by the CauMy of Burrrett Wkmmin in 4krminirp whether m Issue a permit 1 _. o — S <br /> furtheramep[all liabilitythatmaYbea r ftatheC avoraurr mM"mMisinmm n[am pmvidirginthk i^ti -v <br /> application. [agree m permit mon olHcials Na ed with adminis[raOn coun ordinances or other a ussixet — �5" N <br /> Monty rq g ty Person m n 5 : o v 8 o r <br /> have actsnmme abowdesaibed preMucman rfa abkti a mane WToseofinspdtlon. _ > : Wtiar) <br /> oD <br /> OWNER'S SIGNATURE < n n E <br /> (dameL9 <br /> ZONING ADMINISTMTOR L' <br /> Z� D <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS%Uft%97 r COUNTY <br /> ZONING s o 0 <br />