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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g � <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER Jerome �1eI`I Lj/ TELEPHONE �sl ��`� �� <br /> nlu-C11 ra5y g6-3 0041 = o <br /> MAILING ADDRESS <br /> C So/J/ L'• �� J/ S� �,�I(1 M 1 .3 <br /> µ J e5_1 3 0 � o <br /> UU J � <br /> PROPERTY ADDRESS <br /> 6-5—`73 <br /> �A 7 7 InAc to� cJ�+l r-et t CO&C O I <br /> tC 7 0 \ <br /> LEGAL DESCRIPTIONk �C l � _4M a� ° <br /> oasum s �Me3 o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITIONA DECK k GARAGE/ACCESSORY STRUCTURE 0 <br /> <^ 3 <br /> BUNKHOUSE El 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 CA <br /> n ry <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: C�Sb (-.'/00er(ljAtc-Az* !.I <br /> (Home/Cabin; Commercial Business; Bedro m; Deck; etc.),�LL ��[[ n, � <br /> BUILDING CONTRACTOR: Qlr� 2 re <br /> m bt-e v h5( . S7. /N gj <br /> bYpf�Je�^ � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANSzz:�: <br /> o <br /> w� <br /> WILL BE RETURNED. — H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m '' <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 m -0 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O o <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) O = o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK r O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. SO <br /> O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES pp <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. N <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. <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: <br /> O F <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p OC <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 O <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. C <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. f <br /> 7. <br /> n R = 33 ,H, aA ,A <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 0 no ^ w= <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized pe o <br /> access to the above-described premises at any reasonable time for the purpose of Inspe10m W ti w t7 <br /> OWNER'S SIGNATURE ;`GG- cc% ."^. A <br /> o <br /> 'D = mom mm0 <br /> (date) <br /> ZONING ADMINIS OR 0 <br /> a : a <br /> TOWNSHIP PERMITS MAY BE REQUIREBURNETT COUNTY ^ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS2MMG N N o N o <br /> Pvirn} + l e-l'W pi C-ked i4p bl l Terbrh-a- l aif U i -ruelle,- <br /> {o-/a <br />