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C <br /> Burnett County 7410 County Road Kr No, 102, Siren,WI 54872 Office of Zoning Administrator & <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER jC 6J fel. yr�-D�i A"Ll Iu 4j_ TELEPHONE-7 )S— <br /> MAILINGADDRESS Z73$7 .57LDACq�fG ICI(, LtleislrA/ 41I s5/773 <br /> ✓ I <br /> PROPERTY ADDRESS ,S L I,nn L <br /> , <br /> LEGAL DESCRIPTION /07�'/ CSm V Pzyz- A EX f� 41_/rf 1Y1 E O-T 7ZAA/ A r <br /> %M <br /> Gn✓ LOTz s <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 0 59.692(1V)GAZESO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> ro <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 C/QMMERaCIAL ACCESSORY STRUCTU E 0 <br /> STRUCTURE/ADDITION USE: Rai rI p,4a <br /> o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: d IA- J <br /> m <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h 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) t� <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). J w z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 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. S�7 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES �I7 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE '-L 70 Uj o W <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 LQ ( y <br /> NEEDED. (y� <br /> l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. L 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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. S`2i <br /> 6. NOT TO BE USED FOR HUMAN HABITATION. CJ £ <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the dela&and accuracy of all <br /> information contained In this application(Including any accanpanyhp schedule)and I further declare that I remgnme that this 9 W_ <br /> Information I am providing will be relied upon by the County of Bumelt Wisconsin In determIning whether to Issue a permit. I .� v <br /> further aaoept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county officials charged with admNktrathg county ordinances or other authorized person to have S <br /> access to the above-described premises at any reasonable thhe the purpose of Inspection. 58 0 <br /> W n n in 'y <br /> �1 � > 00000 y <br /> /DZS �V Yv.m m0 <br /> OWNER'S SIGNATURE �Z a <br /> (dam) Uq b � Ex <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ERNE[ <br /> D <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF I NCF s Zl)�2 <br /> UL-1 00008 <br /> BURNEIT COUNTY <br /> ZONING <br />