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A, rrtt County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator = <br /> APPLICATION FOR LAND USE PERMITS = L <br /> ffR ( TELEPHONE O <br /> s <br /> FRl',taDRESS <br /> �:10 L �°'✓NT,/ I--1�. C� ��i1 / <br /> Cf gRiPTIOPI � _ <br /> Pr (/1" � r 3 S14- Tooa R11 ./ <br /> of PERMIT(S): SINGLE FAMILY DWELLING ❑ AD'BION p DECK❑ GARAGE(ACCESSORY,STRUCTURE/kb <br /> hUNCHOUSE L 59.6......GAZE130 p STAIRS❑ FILLING/GRADING E) CAMPING UNI'❑ <br /> ..-- .�. .caw:.IEPGIAL-BULLDfNGn[I-CCMMEp.CLAL ADDITION❑-COMr-0ERC[AL ACCESSORY S?P,l1CTURE ❑ - _ _ 3.. <br /> p I-i URDADDITION USE. <br /> (� (Home/Cabin;Cpmmeroal Business{Betobm <br /> !r ; Deck;etc.) <br /> •. .CONTRACTOR:�r I-'- y�L4C�E:1L1TLItr ( T� yl <br /> ^LOT PLAN MUST BE PROVIDED ON AN 8 K X11 SHEET OF PAPER. ANY I COMPLETE OR ILLEGIBLE PLOT PLANS (- <br /> BILL RE RETURNED. <br /> OIRB7 <br /> 10 S FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 1. SLOW THE LOCATION AND SIZE OF ALL EXISTING WILDINGS/STRUCTIRES(ES)AND ALL NEW (yam <br /> 51,11DINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, I C� <br /> MIL`INDICATE NORTH(N). <br /> SHOW DIMENSIONS <br /> OF IN D,(C)BTHE FOLLOWING: (A)BURT(S)TO GS)THE TO AL LOT LINES,(B)BUILDINGS) <br /> G(5) <br /> f0CEN TERL INE , 0.0M, OR BUILDING WELLAND AR(5),A THEORDINARY <br /> NSIO WATER MARK <br /> SHA,J O E LAKE, ONOFSTREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS -� h IV,"1 IRJ <br /> TO BU THE LOCATION OF THE WELL NES SEPTIC TANK(ST)AND GRAIN FIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS, LAKE, LOT LINES. <br /> INN ICA HE IF A WALKOUT EASEMENT IS PLANNED AND SHOW AREAS TO RE GRADED OR FILLED. 7r\� <br /> I. U SEPARATE?CANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE _� �``t�Vd r- I, <br /> PLATS MUST BE SIGNED AND DATED BY THE OWNER. I I l^ 4-- =1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN v 1 Isy �J <br /> NEEDED. i0 1 <br /> ITS pERMIi IS SUBJECT TOALL CONDITIONS LISTED BELOW: ^ <br /> ORP.0VAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN So DAYS OF PERMIT. <br /> REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _iF <br /> NO`°NAOING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> NC STHI ICTURES,INCLUDING RCI AINING WALLS, DEC,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. I U1 <br /> lyV.} <br /> ` ACCESSORY STYUCIUREE MI <br /> GARAGE PERTS ALLO'N FOR'R ATE RESIDENTWL GARAGEISTORAGE ONLY. 1 <br /> NOT TO RE USEO FOR HUMAN HABITATION. <br /> T � <br /> iD^p^> pp <br /> 1'Post this apphInnim(including any accompanying lFhedu!e)M1as been eaamineE by me and to[M1'Eesl°r my % $ 3 ' 3 'c_ <br /> ..,.dge vnd beliefit is true,correct and complete. l acknowledge that l am responsible for the derail and accuracy of all � ,22 <br /> n!tionc°nRinMin1hist. Isinganyaccomp...in,schedule)and l further declare that l recognize that tris - - _ - <br /> povidin Ill be, - I the County of Burnett Wisconsin in determining whethef to issue a permit. I 'ten - - <br /> atteptel!liabilityhatmaehas It the CounlY,of Burnett relying an this information l am providing in this <br /> p tern. taryeeto -,mutt. loI I, rgedwM administrating county ordinances or other auNa tlpersan to <br /> .ccsisa theaha :des<rib pre Pry feas°nbletme for purpose of In <br /> UWNFR'S SIGNATUI E_ _- _ _ _ Is GIGU _ =_- - <br /> (date) (� s`t`1TT1 n r <br /> h, ADMINISTRATOR_ _ �/hl I �II -�WE a - <br /> // p -�V,tJ 111��� - ) <br /> / PE <br /> TOWNSHIP PERMITS MAY BE REQUIRED �U� 3 2013 <br /> THIS P MIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU =_ <br /> ` _ I IBURNETTCOU <br /> ZONING <br />