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it <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrat or n z <br /> APPLICATION FOR LAND USE PERMITS d <br /> x <br /> OWNER S-O feNSe TELEPHONE 6/2. -?;L 33.2 <br /> O <br /> Fh <br /> MAILING ADDRESS KYD� - ]a-ho�� ,� la-jfd�I AJ SS"//7 <br /> PROPERTY ADDRESS ` -.,j q /j (,wood L+A�e OK �'�,a,,,'7r(x„y hrv8 yo <br /> LEGAL DESCRIPTION N tOQ/ OF'r;' 60(9,60V tvr& 4 5 <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE fd ADDITION ❑ STAIRS ❑ o <br /> TYPE OF PERMR(S): � <br /> FILLING/GRADING 0 CAMPING UNIT❑ UNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK I <br /> STRUCTURE/ADDITION USE: f ulz d z <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck; etc.) o ° <br /> BUILDING CONTRACTOR: oa `4usT omu), be! b- Na -7§—'+L-y„ 4oLke- <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Y2 X11 SHEET OF <br /> PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT P5 S n <br /> WILL BE RETURNED. O 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) e <br /> � 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BES OWN OR DRAWN TO SCALE. M O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BU LDINGS/STRUCTURES (EB)AND ALL NEW y B <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, to 'a <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A BUILDINGS)TO ALL LOT LINES, (B) BUILDING S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREME (S)TO THE ORDINARY HIGH WATER MARK W a <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND REAS,AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TAN (ST)AND DRAINFIELD (DF),AND ALL DISTAN S <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. q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,TF E _ <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. e 4 <br /> y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHE 4 <br /> NEEDED. _V p� )IJTHIS PERMIT IS SUBJECr TO ALL CONDITIONS LISTED BELOW I� 9j <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IE 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 1 r SETBACK AREA. <br /> 5. ACCESSORY STRUCTU <br /> 6. RE/GARAGE PERMITS ALLCALLOWF R PRIVATE RESIDENTIAL GARAGE/STORAGE ON Y. <br /> NOT TO BE USED FOR HUMAN HABITATION. �Q <br /> _ q f <br /> n ,hng RnaE: R $eh�'1 <br /> 7. 69 III. <br /> w <br /> I declare that this application(Inducing any accompanying schedule)hin been examined by me and to the best of my knowledq j <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information e p <br /> contained in this applkation(including any accompanying schedule)and I further declare that I recognize that this Information I ^ :KIZ: ;,, Y <br /> am pmviding will be relied upon by the County of Burnett Wisconsin Ind terrnlning whether to Issue a permit. I further accept 1 >Fla, <br /> N='„„, ^' -0 <br /> liability that may be a result of the County of Burnett relying on this Info ation I am providing In this application. I agree to o 8 '^`^ 8 .r, <br /> permit manly offitlals rhargad cath a Inistrating county ordinances or Cher authorized person to have access ro the above- <br /> described premises at any reason, •for the pu of inspection. y <br /> OWNER'S SIGNATURE 4lCltf/Je+t Sl9/b7 n 's1 S <br /> < X <br /> (date) c H: S >w' <br /> ZONING ADMINISTRATOR y :1.g <br /> TOWNSHIP PERMITS MAY BE REQUIRED ? V <br /> THIS PERMIT SHALL EXPIRE ONE YEA FROM DATE OF ISSUANCE <br /> 3 <br /> , r <br /> rt <br />