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Burnelt County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS s; 4 <br /> OWNER \I�I J ,�eN K1n_ -. I TELEPHONE / �1 <br /> MAILING ADDRESS <br /> i1 (.� <br /> PROPERTY ADDRESS 2-(Y ,^t-t(/ <br /> 7755 /V 1 IJpnner l.mke eL / T/1-C <br /> ,,I w,v <br /> LEGAL DESCRIPrION , 9O_CwNyatw fo q pf;m 3S (nUJt kol 3 r� <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING D ADDITION D DECK D GARAGE/ACCESSORY STRUCTURE❑ <br /> BUNKHOUSE O 59.692(1V)GAZESO ❑ STAIRS ❑ FILLING/GRADING❑ CAMPING UNIT fjI� I e <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION D COMMERCIAL ACCESSORY STRUCTURE D _ N <br /> p�pCL <br /> STRUCTURE/ADDITION USE: I S —aT I J <br /> (Home/Cabin; Commercial Business; Bedroom; Dkck; etc.) <br /> BUILDING CONTRACTOR: -a <br /> m p I <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c( <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) R ' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE, r, <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES FEB)AND ALL NEW i. <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Cy <br /> AND INDICATE NORTH(N). N i <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ` <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. a q1 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES w <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5' 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. {p <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. E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN u <br /> NEEDED. n.I <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. �1 O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 9 z <br /> T NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER t <br /> SETBACK AREA. O }l I <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 1 / <br /> NOT TO BE USED FOR HUMAN HABITATION. - <br /> 6. <br /> 7 span ac <br /> 1 dere that Has appbation(Iocludhg any a®nrlpanryag sRatule)las been ocambad by me ano to Has best of my 3 0 ;°. <br /> kroaledW and bellef it is true,correct and complete 1 aclnav eNe that I am esyw6lble for Ne delall and amrratf,of all <br /> to <br /> Intonation mnlaNei In m6 application(atluaing any a®rnpanyhg srladule)and I further declare that I remgnme that this <br /> Infarratlen 1 am pmvHl m,will be rellpi upon by the County d Boned WlsmraYl In determining whether to Issue a Permit. I <br /> further a opt all Ilabglty that may be a result of the County of Bumett relyhg on Nils hlfom stion I Am provtlbg In this i w <br /> application. 1 apse to permit caul dhialac age4 wtm Blrallt19 murLLy odawites or atlea aaMOee person m lave e 3 [' <br /> a¢ess m the above4=bed M M anY le the Wrpose of In�e[tkvl. m : . ?„%^•r« A <br /> L/ net <br /> = o <br /> oa <br /> OWNER'S SIGNATURE L/ e <br /> / (care) <br /> to <br /> ZONING ADMINISTRATOR -/./TOWNSHIP PERMITS MAY BE REQUIRED a ^ m n m <br /> /v/ A <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS EFEB 1 42014 a <br /> BURNETTCOUN7Y <br /> ZONING <br />