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c rn Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a t <br /> APPLICATION FOR LAND USE PERMITS m n <br /> ,/ <br /> OWNER u 1�� Fkawb�r TELEPHONE <br /> MAILING ADDRESS �. 3 <br /> o <br /> leo I & 6-Y foil.'(' RZ vlra ttSt�r� wL 5`1,40 m 1 <br /> PROPERTY ADDRESS <br /> R1 1=ya���,1, wC s`tY311' — — <br /> LEGAL DESCRIPTION <br /> S6I/Li 1/4 , Sati r37a, Rttiw <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING9 A15DITION 0 DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT O (h <br /> COMMERCIAL BUILDING D COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ O <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: h�a4&-A ) �. tv (K4(.10 <br /> � 3 <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h 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) tai <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 tin ,m o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <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 wF. J <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p Q <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES W <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. cn <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. a UJ U) <br /> J 9.J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ...I <br /> NEEDED. Oot <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> a Cl d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <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. vV <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F ) <br /> 6. <br /> 7. > o 0 o ry > p 7 <br /> 6 <br /> I declare that thls 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 detail and accuracy of all o, m m d m b, H <br /> Information contained In thls application(including any accompanying schedule)and I further declare that I recognize that this o `- > > m N a <br /> Information I 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 be a result of the County of Burnett relying on this information I am providing in this <br /> applicatlon. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ,r, <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. m w d o W H-o o y <br /> c000 � o � <br /> OWNER'S SIGNATURE )� /)(/ if n > o ct° w p = Z <br /> �irn Fla (date) <br /> n (car, d <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED A <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ^N �`" <br /> and+ d I� ��� �o(crWin/ � hy tY), / kMt.berb <br />