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C p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g � <br /> APPLICATION FOR LAND USE PERMITS <br /> _ a <br /> OWNER jErizcf LA2Se/�l gfo& - g33 <br /> TELEPHONE-,IS_ -7 d <br /> G J � o <br /> MAILING ADDRESS OL 7508 LQ a <br /> kill PROPERTYADDRESS —lOQ3 000LEGAL DESCRIPTIONTyOti l(cw NetiL o <br /> TYPE OF PERMIT(S): SINGLE-FAMILYDWELLING ADDITION0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0BUNKHOUSE 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 S <br /> STRUCTURE/ADDITION USE: ala.61 n Lj if A ,DQfZC .. o <br /> (Home/Cabin; Commercial Buslnkss; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: f ) n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 0 <br /> WILL BE RETURNED. ©NSIt)t,* $-3 0-0 Q a u y <br /> f1 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M p G <br /> 1. ALL REQUIRED 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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, P <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) °� <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. d <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES '. I <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 0 <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 ...I i <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d <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 /> o 0 o m c <br /> 7. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my W w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all E. a c td N Y <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this <br /> application. I agree to permit county oMi Mill cIn ed with administrating county ordinances or other authorized person to have � � N�w <br /> access to the above-described premises ata re onab for the purpose of Inspection. �� 1J r \ -' a 8 g c $ o y <br /> rl IF I ' o l / i iI li I <br /> C�.� Jam' \Jbr rys�a g <br /> OWNER'S SIGNATURE I U 1 'Wc <br /> (date) <br /> MAY 2 ° 2008 u o B _ c <br /> = <br /> ZONING ADMINISTRATOR i <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY6. <br /> �NING I �0 8 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA 0 S <br />