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H z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a CA 9 <br /> APPLICATION FOR LAND USE PERMITS r <br /> OWNER Frattlel N �aV j TELEPHONE <br /> MAILING ADDRESS Q [.l <br /> 13 a lllA4e l'YO U2 <br /> PROPERTY ADDRESS Q ^ <br /> l-NY` <br /> LEGAL DESCRIPTIONC I LJ A V�,F �`/ Sif / / 7-31 T/� <br /> / (0 c t <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADOITION1 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 I^ <br /> BUNKHOUSE 0 59.692(IV)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 e <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRU/CTURE Q 5 P <br /> STRUCTURE/ADDITION USE: �Ci1 I n.. � "`J 0()V (A.(p( <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 90 <br /> I^ c 1k <br /> BUILDING CONTRACTOR: !NW <br /> n <br /> i4--o <br /> A PLOT PLAN MUST 8E PROVIDED ON AN 8 Vx X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS � c <br /> WILL BE RETURNED. 0 <br /> T G <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c: I v <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). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> ol ' <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. O .� <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. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. In � Gl <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE KJ ' <br /> 3 <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I� i <br /> Z <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. <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. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. <br /> ,p 9 <br /> h n n <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 detall and accuracy of all <br /> Information contained In this apPlicatlon(Including any accompanying schedule)and I further declare that I recognize that this , ; Y <br /> Informatlon I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I a' _ <br /> further accept all liability that may be a result of the County of Burnett relying on this Infonatlon I am providing In this z j;,, = ; -6 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-describe d p es a[any rea nable <br /> C1 tl r the pu of Inspection. <br /> OWNER'S SIGNATURE�/V / L0� <br /> (date) _ <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED Ga I n <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE "N N <br /> r� 8o � o � <br /> U+P _ (/artc nc2 --#7D r7 X09 <br /> CDur'f^DrdVr �ar yN�u�c�lu� r2�le� aU7�eh r(Lof� <br /> y- 39-cc1 To a&OW pd,-111iw✓ <br />