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ro Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> (' AGPPLICATION/ FOR LAND USE PERMITS / y <br /> OWNER L -)'1rP�1 C. n L(,1'Ie. 1rYl(� TELEPHONE <br /> J 65/ -&FO <br /> MAILING ADDRESS D I'l" 5k n�rni t -4ve, 51. A olj /'y)N SS/OS V <br /> /O-� �/�7)O <br /> PROPERTY ADDRESS �y7,�,� L./eW e.(L. <br /> u p / o <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE✓-IFJAIMILY ID�WELLING(❑_ ADDITION DECK(�D'ECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ �— <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r <br /> ro <br /> STRUCTURE/ADDITION USE: Porch av)ce 5 o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: '71-C) -2,20 '3.3S <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. c r? <br /> c V� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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, o <br /> AND INDICATE NORTH (N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) o C� <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK C7 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. 9 Oo <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. m <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 o <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 y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTSIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RES ED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED ESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,AL LO ED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 41 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> y <br /> S' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the bat of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accwrecy of all <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this > a m N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I .e w c w <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 person to have R <br /> access to the above-described premises a[ y reasonable time for the purpose of Inspection. rt > 8 0 <br /> 0 0 0 <br /> OWNER'S SIGNATURE �Gl i/WvJ r) <br /> (date) o $ 3 8 �. z <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> "s <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />