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Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 ° <br /> APPLICATION FOR LAND USE PERMITS y <br /> s <br /> OWNER ` cl r�A0f TELEPHONE &L '— ._33n- 0J <br /> 111 T O <br /> MAILING ADDRESS ` 5 39 S h I e-y <br /> 5 S-c 7-525« I <br /> PROPERTY ADDRESS �Sht. Z 1 <br /> i,v e,bs ie_v- <br /> LEGAL DESCRIPTION L o t 3 C 5 M ✓ ) P Rol I CTrI Coy- Lu-! -S) 3s- rill-15 <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ID STAIRS ❑ v' LA <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADINNG ❑ CAMPING UNIT E] BUNKHOUSE ❑ 11591/.692(1V)GAZEEBO ❑ DECK I❑ <br /> { <br /> STRUCTURE/ADDITION USE: I 1 omr — ROXUAT(ONI�4,M LhU i^' <br /> (Homee/Cabin; Commercial Business; Bedroom; Deck; etc.) o (t <br /> BUILDING CONTRACTOR: fese C rN <br /> �) I I �> vIJ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O0 - <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). C� v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) N , Z <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK , p <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. 5, <br /> 4, SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES _5 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 444 •��` -i S <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. �N £ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE. STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. in <br /> y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: UI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n p <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 n <br /> SETBACK AREA, <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. Fl <br /> 7. £ <br /> gy <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge � � DnwOD07 <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this information I <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all w ! H <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to a - <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for the purpose of inspection. �,o w o "a <br /> OWNER'S SIGNATURE n v✓ Y _ !u o _ y <br /> I "� (date) n �+ <br /> ZONING ADMINISTRATOR \J I � ''/1�G�(77 1 0 <br /> c rn 6 D n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ul 1= <br /> See Pim, o <br /> I '6 � 4ce Sf:Y v ArclA �jn�4tcc c� <br /> 16a/w (Cance*• re./ �! � , <br /> I <br />