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e Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator $ <br /> APPLICATION FOR LAND USE PERMITS y: y <br /> o <br /> OWNER { �.qA I yAm (J./_ TELEPHONE&51-6053-3370 a Q� <br /> 4 I'1 IZ n q m B <br /> MAILING ADDRESS/J/ rO C ��/0... P / 1 \p (�-�(Zo,,,i• ] K MA 55_1 7 q <br /> ''f{9V J CX& �"� /� '�-nl l wJ R 4..J1-YJw /�I7ti <br /> PROPERTY ADDRESS �(_g oC. �Y LC t1 yin n� 0�1 i �W � � \ <br /> lJ MX Xo <br /> LEGAL DESCREQSION+ & 3 SCCLt 1 'V 40><¢(�l� oFro,�iet5 s <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURES <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT❑ ,2 <br /> ro <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> RK <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; C ercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR:'ricv, w ` n <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> r5 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VIEW) c "a <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 NEWO <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 0 p <br /> AND INDICATE NORTH (N). 7I pN c <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 <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. d <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES (�t� <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. �' 5 <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 <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 v61 y I <br /> NEEDED. V l <br /> THIS PERMIT IS SUBJECT TO ALL CONDTTEONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 0 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. o <br /> ` D 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDEN1TIALLG.A/RAGE/STORAGE ONLY. <br /> 6. NOT TO�7 JBGC{USED <br /> /'e IVR b 2HUMAN <br /> 7 HABITATION.c3 Qui" �'r'cJF'n �{roh� !�/ HR Z- f <br /> 7. T � � 0 0gg g0g _'ate <br /> I declare that this application(Including any aoo)mponyaq schedule)has been examined by me and to the best of my 3 0 <br /> knowledge and belief R Is true,correct and complete. I adaaaAedge that I am responsible for the deteli and accuracy of all nm I- F_I- <br /> a <br /> information contained In this application(Including any accompanying schedule)and I further declare that I recognin that this .o E.> > m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In debermining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this In N b <br /> application. I agree to perrnit dlldaLs charged admin n courtly ordinances or aef Phascn to have a .2 c g : 0 8 nrr <br /> access to the above-desai lees at erry M I Ly a <br /> 2 g > ogoo <br /> ri 6G�(1 HM C <br /> OWNER'S SIGNATURE ce a o. a E x <br /> ZONING ADMINISTRATO UG 2 3 2010 x �i M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSE C�N N N$o 0 0$ <br /> ZONING <br />