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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ro z <br /> APPLICATION FOR LAND USE PERMITS . <br /> y 1P <br /> �W ibbe� t liolene atherlF� ` <br /> TEE PNr-'/3� 2� e <br /> MAILING ADDR S �° <br /> 55 rnLt r Ln IJ a l l wa&e- M0 50P2. <br /> PROPERTY ADDRESS <br /> M-03 S 'Bt)nrr r LgL0. ,' d a , <br /> LEGAL DESCRIPTION Lod 2 Csm V A f 137 6rk4 LOf S <br /> TYPE OF PERM[T(5): SINGLE FAMILY DWELLING ❑ GARAGE/AICCESSORY STRUCTURE ❑ ADDITION l7 STAIRS ❑ <br /> FILLING/GRADING ❑/CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ( <br /> STRUCTURE/ADDITION USE: Rikls69 P4TAj -)/ &,K J+dAOE /b & I�AdAG4 1$X 36 I J y <br /> (Home/Cabin;pCommerciall Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: C)LO ,1' <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF R. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BOILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, to ro <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) l c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 3 <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND'AREAS, AND(D) LOT DIMENSIONS. N ? <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DISTANCES °c o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t7 y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE G — <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER; 5. T <br /> ti L� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c' l J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 2 C> 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n vl <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. NOT TO BE USED FOR HUMAN HABITATION. „ ^ <br /> 7. <br /> o Ry >nw ROa Fv <br /> I <br /> declare that Mb applkatlon(Including any acoompanykg sdweduk)ha$been examined by me and to the best of m Imowled '� °j <br /> and belief It Is true,correct and complete. I ack nowiedge that I am nsible for the detail and accuracy of all Information x `�'' H <br /> contained In this application(kK*RlIng any accompanying sdKdule)and further declare that I recognize that this kdormation I is g <br /> am providing will be rclkd upon by the County of So to Wisconsin In=Inig whetlner to[slue a permR. I further accept as ckuc <br /> r; w ^`+ 57 <br /> liability that may be a result nf the Wunty of Burnett relying on this Infof oration I am proMdbg in this application. I agree to o8 described permit county alikJa� wain adminictratlrg County ordinances or lotlner autlwrized person to haws access to the above- Spremkes at any nensonebk time for the purpose of In, G1 y c <br /> OWNER'S SIGNATURE AT�.I-1� .GL- A7t..(i� ,j'3Q'Q7 0 $ z <br /> ZONING ADMINISTRATOR_ �-Jr' I , �.a � <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FR M DATE ISSUANCE N g N o <br /> �erm� �� 1e1 mc( tedto a�/+ I �,- s`Or) <br /> � ~ <br />