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i <br /> j Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator y <br /> APPLICATION FOR LAND USE PERMITS I <br /> OWNER TELEPHONE <br /> I (�--•may—� `�' _ (rJ Ot(J b D J a I <br /> MAILING ADDRESS /q 7rJ <br /> `T ( J <br /> PROPERTY ADDRESS R q! � � Od ,S <br /> LEGAL DESCRIPTION <br /> Se . as �yDDU ! s <br /> TYPE OF PE0.MIT(5): SINGLE-FAMILY DWC-LONG❑ gDDITION❑ DECK D GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE[] 59.692(IV)GAZEBO D STAIRS O FILLING/GRADING D CAMPING UNIT O <br /> COMMERCIAL BUILDING D COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURED I 2 <br /> STRUCTURE/ADDITION USE: 37, <br /> S P <br /> (Home/Cah.)n—;FCo erUal^mmuslness; Bedroom; D/¢ck;etc.) -- I o <br /> BUILDING CONTRACTOR: I ly-P— <br /> A PLOT PLAN MUST 9E PRQVIDED ON AN D Vi X11 SHEET OF PAPER, ANY INCOPIPLETE OR ILLEGIBLE PLOT PLANS <br /> TT <br /> HI <br /> IL <br /> CK <br /> C DAR <br /> toT <br /> IMEN <br /> d < I <br /> WILL 8E RETURNED, O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL R-QUIRF.D 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 M ? a n <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,(e)BUILDINGS) 0 0 <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK <br /> 4. SHOW THE 0, TIONR0 TIIDCRWELL(1YN 8 PTTIATANK(5T)AND DRAINF EIO.O(DT)I AND qLL DISTANCES <br /> S. 1NDBCATDEtIf-A WALKOUT BASE *TIS <br /> AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6, IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,COIJTRACTOR,ETC.,THE I <br /> PLANS hIU57 BE SIGNED ANO DATED BY THE OWNER. g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED, N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PFRh11T. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <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 I� <br /> SETBACK AREA, <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. <br /> NOT TO BE USED FOR IIUMAN HABITATION. <br /> � <br /> 7. <br /> S�>99oogb � : <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my e R 3 q a: <br /> knolvledge and belief It Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all 7 <br /> Information contained In this apPitcauon(Indur ing any accompanying schedule)and I further declare that 1 recognise that this b <br /> Information 1 am providing will he relied upon by the C <br /> further accept all liability that may be a result of the G ett Wlsconsh In [ernining whether to Issue a permit, 1 <br /> Y In v or 11 r ett relying on Is montane I am Providing In this v' < <br /> flppllatlon, i agreu to permit county aMdals charged Im admlmstre county o antes ar o herN'a <br /> access to the above-dascrlbed Premises at any reasons le B for the pu se of ectio son to have &i3v 2 <br /> J-Vi SyI (OSo 8� <br /> OWNER'S SIGNATURE <br /> V(date) y a U y Ln O <br /> ZONING ADMINISTRATOR <br /> die <br /> TOWNSHIP PER S MAY BE REQUIRED 4 w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> '� ooe <br />