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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 o y �' <br /> OWNER <br /> Ksim (, 1 TELEPHONE o n <br /> M� I"IgKSiY��o� �,12- yGG -1lIG e a <br /> MAILING ADDRESS1 C J5� � r(r 4!, { � '�/I �e <br /> :J 1� /� I <br /> PROPERTY ADDRESS1y�p� Da- A l iy L�j 00t&AYq <br /> LEGAL l <br /> DESCRIPTIOL�II3031D . �fci {(./LxLrV) _ AKlAin "6 ,I(�YC qtf- V'IIIG/L�C , S <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING AD ITI0TN ❑rr �DE.CK ❑ GARAGE/AC ESS RY STRUCiURE�I� � <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITIO ❑ COMMERCIAL ACCESSORY STRUCTURE Elr <br /> STRUCTURE/ADDITION USE: W z <br /> o <br /> (Home/Cabin; Commercial Business; Bedrolom; Dec � tc.) �,` ;Joci <br /> BUILDING CONTRACTOR: I ` } 1 t 1�. u I a 11 L-A 0 11 '0e!" ode b n <br /> � y <br /> 3 d <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o ` <br /> WILL BE RETURNED. <br /> 6 <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 3 <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). N I c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK (z) <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS, AND(D) LOT DIMENSIONS. C7 I <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. U <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 10 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE . c <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. UJ <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: r CXl <br /> I ��VJJ CCw <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I a 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 ru� <br /> SETBACK AREA.5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Cy <br /> NOT TO BE USED FOR HUMAN HABITATION. a1 1� <br /> 6. <br /> 7. = ' S 0 0 0 pE 6 0 m <br /> j nx3 <br /> ; � so5 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all a <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this m °-9 >m N <br /> Information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I I ,°2, ?w< <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In thisWd application. I agree to penult county officials charged with administrating county ordinances or other authorized person to have m .2 88access to the above-described premises at any reasonable time for the purpose of inspection. ° 5 ,3 H <br /> /� > 000000 y <br /> OWNER'S SIGNATURE 1 '`V—)�� '"I�f�3 rh"r"+.h/ �jj"Z <br /> �— (date) <br /> rI 8o5 4I <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N o <br /> � 00000 <br />