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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS a <br /> P ry <br /> OWNER TELEPHONE /r6 rj_L39 a ' <br /> /J R <br /> MAILING ADDRESS ZZ7 iZ a� n /"r. � 33-2 V <br /> (Lp ! <br /> PROPERTY ADDRESS <br /> 2.2-7ZZ Uo ff�.'Sa A0 <br /> ,Slay3S T360 <br /> I� I w C) J <br /> LEGAL DESCRIPTION I of eZ CSM V 1! �3n o y <br /> SINGLE FAMILY DWELLING ❑ RAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STA RS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRAADING ❑ CAMPING UNIT ❑ BUNKHOUSES 59.692(1V)GAZEBO ❑ DEC< ❑ 1L. <br /> STRUCTURE/ADDITION USE: 1—JD b"d ufjvet <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o_ <br /> BUILDING CONTRACTOR: (- 1501-j0-'404 RJ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT 7NS (��-- <br /> WILL BE RETURNED. 1 1 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0� � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tri d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ❑ <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, "o <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 1 <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 0. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w d <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. CJ c <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 /> .-I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN <br /> NEEDED. a <br /> 00 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER J� <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. <br /> NOT TO BE USED FOR HUMAN HABITAr�ON• E <br /> 6• ND pIL(.Mbl, n9 "ls allowed )n-1'h�.S S+Y-LLehLk�, <br /> � aoo � a b <br /> T 2 g. � 6 In <br /> 1 declare that this application(Inducing any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief it Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all Information o g <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this information 1 <br /> am providing will be relied upon by the Cou ett Wisconsin in determining whether to Issue a permit. 1 further accet all O A <br /> liability that may be a result Of relying on this Information I am providing In this application. I agree t p� N <br /> permit county oBYdals rharg with r Ini ria unty ordinances or other authorized person to have access to the o R <br /> above- <br /> described premises at any rc so b time or urpose of Inspection. <br /> OWNER'S SIGNATURE Z' <br /> n (date) � y, � _ > 5 <br /> ZONING ADMINISTRATOR _ `J 1 m Fla -11 <br /> oar) <br /> E . : <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �� o <br /> �' ✓✓n�� a I���er fnailed 1v 5,ucL El f-or-d <br />