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C R Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS : <br /> OWNER Irl TELEPHONE <br /> �1b. wv . �cS! -Yl --7553 <br /> MAILING ADDRESS73 a 1,Yy ��9 "Hcy l fv'. ' (A) 5 ycS-1 <br /> � 1J 1 <br /> PROPERTY ADDRESS J 'n <br /> 1 P ctir�J �f c 0 <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-F/AMILYY DWELLING Jij" ADDIITION ❑ DECK 0 GARAGE/ACCESSORY STRUCTURE ❑ 8w <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: z <br /> (Home/Cabin; Commercial <br /> Business; Bedroom; Deck; etc.) <br /> \ <br /> BUILDING CONTRACTOR: h.`a�S rvI <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c K <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, a <br /> AND INDICATE NORTH(N). h z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) N o <br /> TO CENTERUNE 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. po W <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. a �, <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 o BJI <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. In <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y C� <br /> NEEDED. <br /> THIS PERMIT IS SUB3ECT TO ALL CONDITIONS LISTED BELOW: ,— <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, n z <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. s �O ^ r) r) 36 7 <br /> RSR B 6= <br /> S <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my k o� 9 5 9 S w' <br /> knowledge and belief It Is true,correct and complete. I admowledge that I am responsible for the detail and accuracy of as E:E <br /> m E :a: `y <br /> Information contained In this apparation(including any acoompanying schedule)and I Nrther declare that I recognize that this ^ 9 Y m % <br /> Information I am providing will be rolled upon by the County of Burnett Wisconsin In determining whether to Issue a pennIt I $ c a w= <br /> further accept all liability that may be a result of the County 0(BhnmeU relying on tlhle kdormatbn I am providing In this <br /> application. I agree to permit rnu oflldels charged with adminletratlng county ordinances or other authorized person to have <br /> access to the above- at any reawnable time for the purpose of Inspection. <br /> °' I' > g"o88 � <br /> OWNER'S SIGNA <br /> (date) rA @ 5 5 <br /> ZONING ADMINISTRATOR <br /> y <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF CE «=N»» <br /> SEP 92009 ,". 80888 <br /> BURN TT <br />