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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS F ILS` <br /> ) TELEPHOE OWNER _'� 0, jCnSJh <br /> MAILING ADDRESS (I J `nAlIl Vyf 15') SM(oI�)n`J� 7Y�DP7'J oo <br /> S <br /> PROPERTY ADDRESS o� <br /> �y'-� OL o s l <br /> � <br /> LEGAL DESCRIPTION s a s -faO N >Z 14 <br /> WUa N w N _ <br /> TYPE OF PERMIT(S) INGLE-FAMILY DWELLING ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(IV)GAZEBO 11 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE �-Y ee-rh fli - c <br /> (Home/Cabin;Commemal Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: SELF F L m <br /> tV^POSED Z -on 'IoWEUJ r _� IN <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS i6N` <br /> WILL BE RETURNED. <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 <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). V' <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)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. o. k o <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. - cN <br /> S. 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. TO N i N <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. W ^ a m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O h <br /> 1� n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ^F+ <br /> 2. REMOVAL OR CURING OF LATREES AND VEGETATION O RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR ESS INCLUDING REAININGALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER X <br /> SETBACK AREA. l C <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRNATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABRATION. C <br /> 6. � C <br /> 7. s -S ^ nnnn > or <br /> 1 declare that this aw icstion(including any aeoompanying schedule)has been examined by me and W the best of my 3 e 7 a c <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit I - > <br /> further accept all liability that may he a result of the County of Burnett relying an this information I am providing in this ma <br /> application. I agree to Permit county amends charged with administrating county ordinances or other authorized person to <br /> have access to the above-descri d premises a ny reasonable H for Me P se of inspection. F m > <br /> Y c � ' <br /> OWNER'S SIGNATURE - /+��-IVJ - <br /> ��.ac�' nn ECCUdC <br /> 20NING ADMINISTRATOR = : <br /> TOWNSHIP PERMITS MAY BE REQUIRED MAY 2 2014 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU <br /> BURNETTCOU u " <br /> ZONING <br />