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C 'd O <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator g / a w <br /> APPLICATION FOR LAND USE PERMITS Z <br /> OWNER irR iG LunG(frn TELEPHpl4lls�,/,,,5 ' �.3 <br /> MAILING ADDRESS' 4--Z eour /(7� /'7� CCS 1 <br /> tV ZUcL� LZ V lr nf1 ; <br /> PROPERTY ADDRESS <br /> J <br /> LEGAL DESCRIPTION S 4 <br /> TYPE OF PERMIT(S): <br /> SINGLE FAMILY DWELLING C GARAGE/ACCESSORY STRUCTURE C ADDITION C STAIRS C <br /> FILLING/GRADING C CAMPING UNIT C BUNKHOUSE C 59.692(1V)GAZEBO C DECK C <br /> n <br /> STRUCTURE/ADDITION USE: 5+0 <br /> Yo1q e Or> NO j3u N K I"FO t4F . <br /> (Home/ m;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 <br /> BUILDING CONTRACTOR: <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN S Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O � <br /> WILL BE RETURNED. 7e < <br /> O ° <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 C mV <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, 'o c <br /> AND INDICATE NORTH(N). v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) z <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES C 'Z> <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. (,V <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n .� <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. c ( ,, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 1p" <br /> NEEDED. !l1V111 I <br /> H <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n O <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 Z <br /> SETBACK AREA. 4d <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. } .� <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge 7J >n m > ty ht <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information A n ^ E <br /> contained in this application(including any accompanying schedule)and I further declare that Ic:c <br /> am providing will be relied u recognize that this tInformation I <br /> upon by the County of Burnett Wisconsin in determining whether to issue a penult. [furthehe Pr accept all o .Z w ° ^Q <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 permit . m 2 H <br /> county officials charged with administrating county ordinances or other authorized person to have access to the above-described 6 <br /> premises at any reasonable time for the purpose of Insnay„ in N 19d <br /> r <br /> OWNER'S SIGNATURE_. l��Q Q- �*-sz.�¢a�✓ �J"Jr�? <br /> (date) E� O N P y <br /> / /�� <br /> ZONING ADMINISTRATOR �/ '�� Ir(Q/1 (�kvi l�, O 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED H <br /> THIS PERMIT SHALL EXPIRE ONE YEARFROM ATE OF ISSUANCE c <br /> /m e 4-- l e4 lC �eol u{� j Gia aj u9-�- <br /> V_ H: <br /> W p W N lyn <br /> N p yU p <br />