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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PERMITS N <br /> Q' N <br /> C <br /> OWNER TELEPHONE ,/'/� J!`6� <br /> IV; <br /> , Go G 11`//,an / KJ 7� O <br /> MAILING ADDRESS F9X <br /> 0 <br /> PROPERTY ADDRESS 1 //� /DYIG, /l� K / <br /> i X li /✓r Gf <br /> T <br /> LEGAL DESCRIPTION40 27-)-y an"y,U e,lY'Lw""f <br /> TYPE <br /> OF PERMrr(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE' m <br /> 0 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> ^o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ r" <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) GS # W 4"h <br /> BUILDING CONTRACTOR: U i✓o Oh - 2_ a 4x <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. G.I <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) �y <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, C> 3 V EI <br /> AND INDICATE NORTH (N). v N J o <br /> 3 TOOCENDT CENTERLINE OF ROAD, (C) BUILDING MEASUREMENSIONS IN FET OF THE FOLLOWING: (A) T(S )DTO THE)O ORDINARY HIGH WATETO ALL LOT LINES, R MARKING(5) 5 iI)J <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. " a J <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES in � <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> 1. <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 /> b 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHENjj <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. J n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. L11 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED 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. 91 <br /> 6' 6,XfW. Eo b. 155.eve via. 2WAV04e, 1.0-a Cit- *rmft A-PAIC'4&n- P +f(ovc 51A+/'Z <br /> 7. > 0 0 0 � > 'C <br /> n � <br /> N 2 0 3 3 c <br /> o E <br /> 2, <br /> ? <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 ,2 w <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all EL �O <br /> 9 P 9 Po q' � m °—01 p1 <br /> information contained In this application(including any accompanying schedule)and I further declare that I recognize that this o g. D > <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 2- <br /> further <br /> further accept all liability that may be a result of the County of Burnett relporoion I am providing in this <br /> application. I agree to permit county officials charged with administrating th authorized person to have ° d 45 0 0 oo t' <br /> access to the above-de premises at y e for the puoww , F) <br /> >OWNER'S SIGNATURE '� >2Ca "�/4 ��5 ECS ZONING ADMINISTRATOR H �TOW IP PERMITS MA MAY 3 0 20 2` <br /> THIS PERMIT SHA EXPIRE ONE YEA FROM DATE OF ISSUAN o U N a <br /> BURNETT CO 'N <br /> ZONING <br />