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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator v o <br /> APPLICATION FOR LAND USE PERMITS a <br /> Aft✓ 1 ,t� '//y��� ,�L }I / -7 q <br /> OWNER ,/✓yIG��bo5yr116I. *) ey& (r� ,(`O�/� '� / 7// v <br /> MAILING ADDRESSeg/ /7 / 4 cy A.J 7-Y l�£�1 <br /> hC (o ll jo <br /> a <br /> PROPERTY ADDRESS <br /> co <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING`❑ GARAGE/ACCESSORY STRUCTUREX ADDITION 0 STAIRS ❑ o <br /> TYPE OF PERMIT(S): ,o <br /> FILLING/GRADING 0 CAMPING <br /> UNIT ❑}�BUNKKHHODU'SE ❑ 59.692(1V)GAZEBO 0 DECK❑ <br /> STRUCTURE/ADDITION USE: �7 d,e�" d-. LZ)g. Y <br /> z/ <br /> (Ho^-m <br /> mee/CCsabin; Commercial Business;; Bedroom; D rP <br /> Deck; etc.) - -Q.. <br /> /` <br /> BUILDING CONTRACTOR: . ' - UE.f'S ar e?rp 'ecp / -I- <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C <br /> WILL BE RETURNED. <br /> o 2. <br /> o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnl I a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW y s <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) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 9 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. Z <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. w' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE q, <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. F. <br /> -3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Zp <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !y I <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER IT -- <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> n .R7 Dr1m Xy DOro <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge C <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o y <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize that this Information I A Y <br /> am providing will be railed upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all c N <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 <br /> permit county officials charged with administrating county ordinances or other authortzed person to have access to the above- 8 ,� A <br /> descrlDed premises at any reasonable Urn for�pofn. „ m a '_? ➢ <br /> � '�. <br /> OWNER'S SIGNATUREt� "`EST/rSE•C/T <br /> (date) y 'o S D Ky <br /> 0 <br /> ZONING ADMINISTRATOR Jim 7'Y)� <br /> TOWNSHIP PERMITS MAY BE REQUIRED »_ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v 8 U <br /> mid fK,� yOic �a �{ by ( ,"rv- Lun2�n Y-�4 <br />