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N b z <br /> c � /o,\ <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator c )✓�+ <br /> APPLICATION FOR LAND USE PERMITS � � <br /> � C <br /> a 'r, <br /> (� � V <br /> OWNER \ `�' 1 TELEPHONE 11�� ��`� d <br /> MAILING ADDRESS �, 11 1 � (/�__ � � (�� i �e�/�dff /�i S.�S�� � <br /> �.l �O _�(���r\`cam\J\V\ �( l l4?. IA/I .�' l <br /> PROPERTY ADDRESS ��f o , <br /> P�.9-' r <br /> 0 <br /> LEGAL DESCRIPTION <br /> /„oT �{cst1 Vol /2 /y 2/D� 6i�•Lo7 /V%//, score;.. 2, 3S -/� �wc-/ o <br /> Type OF veliMlr(s): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE � ?. <br /> _ d <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ � V\ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S '� <br /> STRUCRIRE/ADOIRON USE: <br /> Stir�C /Z'x/G' ° <br /> (/Home/Cabin;Co ercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: V 41� �. ��'2t Q.-r�/ ,.,.1 <br /> V � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS � � '� <br /> �n � <br /> WILL BE RETURNED. � (1 ) 'D <br /> l7 J" 6 <br /> t+9 O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL IXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW D o <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, J N a <br /> AND INDICATE NORTH(N). O � c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES,(B) BUILDINGS) �j �' <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK � O <br /> (OHWM)OF LAKE,STREAM OR RNER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. ' <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES W 5. �, <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. b <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN � l � <br /> NEEDED. � �}� � <br /> THIS PERMIT IS SU67ECi TO ALL CONDITIONS LISTED BELOW: � v �,C`y' <br /> � `° z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. � � a <br /> 2. REMOVAL OR CU1lING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. � y <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Obl' }-{� <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. `< <br /> 6. <br /> r, 7� a � � � nao -d <br /> 0 0 0 � c <br /> ' F n io 3 3 � c _ = � <br /> I declare that this application(including any aaompanying schedule)has been examined by me and to the best of my 3 0� � � _ � :' <br /> knowledge and belie!it is true,rnrrect and complete. I acknowledge that I am responsible for the detail and aauracy of all � � W � m w � ; H <br /> information contained in this application(inclutling any accompanying schedule)and I further declare that I recognize that this -. � a CJ N : y <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m � c o.as� .O <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this � � g, : in; '^,�, 't7 <br /> application. I agree to permit ty officials charged with administrating county ordinances or other authorized person to � � °i o ; o o r., <br /> have access to the above-de ibed miles at an rea ble time for the purpose of inspection. °� � ���w ti,'^., (� <br /> c 27 `° y 000c ,D,I <br /> OWNER'S SIGNATURE I � a A o.o g <br /> .. <br /> c a . 9 � °' _ <br /> ZONING ADMINISTRATOR S ' /n"' " §9. � � � '� <br /> �O '� °c uo ° C) t"1 <br /> TO NSHIP P MITS MAY BE REQUIRED ''' <br /> � � .. w' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g <br /> :A�: :: e, <br /> Eq� N6969690 <br /> U vNi OOp 00 <br />