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c � (o� <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g (� � U'J <br /> APPLICATION FOR LAND USE PERMITS y N � <br /> e <br /> OWNER TELEPHONE '' <br /> .�emn r- J u 1 i a° (nln r{'S7�>°n S c+� 71�—y83- 113.5 <br /> MAI LING ADDRESS���/_ �� � �� � Cr.0 I X la/�S i W! - ��L�iZ� III � �///''' (�� <br /> PROPERTY ADDRESS �(���p�� � <br /> SE sE Ex PRT LYC* S E o� �• "� <br /> LEGAL DESCRIPTION r' <br /> w� 35 S z7� e o ° <br /> TYPE OF PERMTT(5): SINGLE-FAMILY DWELLING ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ � <br /> BUNKHOUSE ❑ 69.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ � � <br /> ro - <br /> COMMERCIAL BUILDING��❑^^ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o � � <br /> STRUCTURE/ADDITION USE: ( _cL IO I n o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRALTO R: n O� <br /> O � ('� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � o y � <br /> WILL BE RETURNED. � � � <br /> ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m d <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � � n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW m w '�' ° <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, S � a <br /> AND INDICATE NORTH (N). I N � z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) p $ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK � �� O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. � p .� <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. � 5' w (� <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 Q <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. � � �l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ..i <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � r � <br /> � � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. � n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p 8 � <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. V <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. �, <br /> 6. <br /> 7. � Stiao o o � d ° `° <br /> � n <br /> � zo � 33 � 0 �' <br /> [declare that this application(Including any acoompanying schedule)has been examinetl by me and to the best of my 3 0 ,Z R ? w � <br /> knowledge and belief I[Is true,correct and complete. I acknowledge that I am responsible for the tletall antl accuracy of all o. m d i"v _� rn ; i � <br /> information contained In this application(Including any accomDanying schetlule)antl I further tledare that I recognize that[his .� �. D 9 m N ; a <br /> Infortnatlon I am providing will be relletl upon by the County of Bumett Wisconsin in tletennining whether[o Issue a pertni[. I � a $�= � .p <br /> further accept all liability that may be a result of the County of Bumett relying on this information I am Drovlding In this � '� y ;n v,`��' � „'^, b <br /> application. I agree to permit county ofFlclals charged with administrating county ordinances or other authorized Derson to have a d,°� o o o o <br /> access to the above-described Dremises at any reasons ti for the s ec[lon. � � � ��w N,,, n <br /> � A )/ 6 O y <br /> OWNER'S SIGNATURE �!� �/�I /I � � j �' m � p � _. O <br /> ��-�I--' ^ date) c °6'.°� �a � ^w�'o� Z <br /> ZONING ADMINISTRATOR , /i� ��Qn(L'�h " C�+,°°,��y � ^°° y ° � �' <br /> O, m � i �a tl1 <br /> d - ° E. <br /> TOWNSHIP PERMITS MAY BE REQUIRED � o °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE `� O�+`"N����' <br /> 7—�`Y� � � S0000 <br /> �✓M f -�'d-l�-�-lel i'VIGt,a�eF� � ����L� �l/-i_sf-CnJ-en l <br />