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G n Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER A/1R TELEPHONE ° w <br /> f^ 11CHA�� MAJE2i_� l�oial baa s�3� d <br /> MAILING ADDRESS -3G 944 1 A V2 SO 'i TNI PL-S, /04 <br /> PROPERTY ADDRESS R 1(115) (,35-4tiWo3 C —. <br /> \ as <br /> LEGAL DESCRIPTION 5 a g q0 ; l4IYI/ SFYy IJt�� (Z10 AocesJ S `� <br /> TYPE OF PERMIT(s): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK R GARAGE/ACCESSORY STRUCTURE 11 v, <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 q <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 d <br /> STRUCTURE/ADDITIONUSE: D cC_k< l P02C+4 CC,K7-F IorJ��d�,3,v� fo tvs�r+�C� ` R. <br /> S z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) o�uc J o <br /> BUILDING CONTRACTOR: L 1— <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS S <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. K O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW m w o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 <br /> a <br /> AND INDICATE NORTH(N). 7 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S) 0 9 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK �' O <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. Cy <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES � p� <br /> TO BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �, c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE p\ _ <br /> PANS MUST BE SIGNED AND DATED BY THE OWNER. 7�) oNQ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN Cq <br /> NEEDED. <br /> � G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ^ Z 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d <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. <br /> S. ACCESSORY STRUCTURE/GARAGE Pt,,MITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. Do 0 o ny0 <br /> 3 3 3 2• rz <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge g <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application(including any accompanying schedule)and I further declare that I 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 <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- ^ m,2 o g ; 8 g <br /> described premises at any reasonable tim for the rpose of ins ion. sw w N,,,u N u <br /> �Q c �. $ �, � 8 $ ' <br /> OWNER'S SIGNATURE <br /> �II �.Q/7141L (date) <br /> OR ii 3 6 <br /> ��r Cb a <br /> ZONING ADMINISTRA <br /> o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ' <br /> pe�m��-�-l�Yle�rna�1-ed � �icha�l /Y]�Je✓l� �19-�9 1 <br />