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N O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS w <br /> o � <br /> OWNER HCLt-K Welt,�ho A TELEPHONE -7tP3_-J51A _ 3451 o <br /> MAILING ADDRESS 14011 C Ie. &- WLZ RnClovCY HQ 55301 � <br /> PROPERTY ADDRESS /� �aCIY)P. DY OUY12-Y <br /> yds Sp Lo 1 5,4 Bo I 1 p <br /> LEGAL DESCRIPTION T 4ON SIB n 1 yL�) /5-433—p r <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ IV, t; S <br /> r1rtt � <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> ttl" <br /> STRUCTURE/ADDITION USE: UI kL <br /> c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: I'1 {' 91,1.1.0019, <br /> n� <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o w <br /> WILL BE RETURNED. 0 — c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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, v d <br /> AND INDICATE NORTH (N). Z d <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 w <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 q , <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ` O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> O W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I y C� <br /> NEEDED. O <br /> 4 up <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t <br /> 5 E W <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. p+ C <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 qi <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. / <br /> 6. SuFFer Reer,W Mb'( 1e re{ereX )f'S/ae/Jq( Pr//cr eyt"j rs doferaac.( fa 6e o(efec+�, f <br /> 7. Ad > n0na > 0v <br /> I de fare that this application(Includkg m <br /> any aemapanykg schedule)has been Ihed by me and to the best of my 3 0 3 <br /> knowledge and belief it is true,correct and complete I acknowledge that I am responsible for the detail and accuracy <br /> Informationcontainedlen this application(I Ing any accompanying sdeedulre e)and I further declathat I necogr t®t M <br /> contained In <br /> indomnation I am providing wll be relied upon by the County of au.. Wisconsin in de0rlmiNng whether to Issue a permit. I $ a° a= > <br /> further accept all liability that may beoa rryinK of the County of Bumntt relying on this kdomkMon I am providing In this c m II _,;,, =N K7 <br /> application. I agree to permit con olfl. n larged With admleistnatkg county ordkaroes or other authortmd person to have ° O o o "' : . 8t. <br /> acues to the above-d ribed p %y(any reasonable tkre for the purposeof Inspection, s a Q 8 <br /> � �Aa0000S > <br /> OWNER'S SIGNATURE 1 <br /> �3 7 - il fry y �, c <br /> I (date) 'w a ° 3 Rog; — Z <br /> § w;2 F.o. C5 5 <br /> ZONING ADMINISTRATOR <br /> Er <br /> TOW HIPPER ITS MAY BE REQUIRED 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C <br /> Af <br /> �r y5 <br /> �/df�/u� Uus000s <br />