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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 \L TELEPHONE q5z F71 <br /> MAILING ADDRESS �� V—yl�✓�(� tl� -'— —`__ ` �. \11 C <br /> PROPERTY ADDRESS /Y�� .� `\ \ ^� 0 <br /> LEGAL DESCRIPTION \ \'Z �1 \ "C , _\1, <br /> Tree OF PERMIT(S): SINGLE FAMILY DWELLIINNGI ADDITION ❑ DECK❑ _GA♦RAGE(ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED - <br /> STRUCTURE/ADDITION USE: p <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc) <br /> BUILDING CONTRACTOR: Com( L,1�xPJc' _ ,-2 <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 /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VIEW) r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN 10 SCALE. +, — <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEN! C> 3 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). f c z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDINGS) /�� <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK C� W d <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. � y <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST),IND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES � - Ir <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 /> PIANS MUST BE SIGNED AND DATED BY THE OWNER. f, h <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN CA <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> L 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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. V <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/SFORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. f <br /> 6. <br /> 2. > �rn » y - <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 F <br /> knowledged belief it is true,correct and complete. Iacknowletl that l am resdetail - <br /> an acknowledge nd(further ec re tt I accuracy that <br /> inlormabommnWinedinWizapplica ' ((m�GIl Ling any ac ompanYin9 xhpdule)antllturMertledare OM1a[Irecognize Ghat Mis 9 � > c <br /> information I a providing I rened upohpIf Co ty of Burned Wisconsin n determining whether to issue a permit I 9 <br /> further attep[all l 01tyt ybea re�noayona <br /> rnett relying on this information lam prowdmgmthis Q <br /> application sag t [county utri witmstrating county ordinances or other authorized person to n C cr <br /> have guess 1p Me ab e-desc,d ed pre ine for Mo purpose of inspection. <br /> ��/��/„U <br /> OWNER'S SIG, RE _ - <br /> ZONING ADM( STRATOR _ �%C iE/ _E-0 CJ <br /> NSHIP PERMITS MAY BE REQUIRED FEB 2 7 2013 �' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU _ <br /> BURNETT COUIT = <br /> ZONING ”"' " ` - <br />