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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER r— TELEPHONE ° <br /> SF4)k►UrS M 1 -7 )�9L4c�- a`sg-1 o w <br /> MAILING ADDRESSp , CrLrv�.ro� AV V_, Ctll-yTol`l WL 64001 re <br /> 1 m <br /> 11-iL Tb <br /> PROPERTYADDRES aquas OLO 3S Rb Z4Ntst.4" Liz S'48 <br /> 'SO o v <br /> < <br /> LEGAL DESCRIPTION1D_I/ o <br /> TYPE OF PERMrr(s): SINGLE-FAMILY DWELLING ❑ ADDITION * DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> ;o <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' I <br /> ri� <br /> STRUCTURE/ADDITION USE: ALD L7 ►y 2,bOiY TD CWIY TiJ&QRC+ I6 Xlle z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.)ra(4ZLOWNCr -0 'Q14 <br /> BUILDING CO TRACTOR: sos Lp C1Il ?b Uj <br /> n <br /> A PLOT PLAN MUST BO PROVIDED Gfi AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C O <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, �_a <br /> AND INDICATE NORTH (N). 90 <br /> N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDINGS) ❑ OOn,P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O W <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 5. Q <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. v, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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. <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 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. n 0 0 0 6 <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m g o <br /> vv ( 9 Y ) Y Y <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all E. to � � � a <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this .o = D > to N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I y v <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this W�o FL <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have Fir L) g o o o <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. SW w N w <br /> OWNER'S SIGNATURE C \-"& Jam` t.. ID —(`I '�� f° �' O' <br /> aam � m + ' <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v d�'r N EA = <br /> Pe�m) � lef ea �cc<<ed�F by Ford Gvldav I a-2;L -09 � U00000 <br />