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C O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> eSt. P•! cEcz��Y,slc-� CQ iLO <br /> 7; �7►y �- ° a <br /> OWNER TELEPHONE 5p'7(p(p Lf 3570 <br /> Yd l)1S w <br /> P,Ickcl (, h I eSjCc n! �- a <br /> MAILING ADDRESS 'r� g0 p Z-1 2 U� S� RQVI4 dp k M tj -596&-G C v <br /> PROPERTY ADDRESS Z <br /> t If <br /> LEGAL DESCRIPTION I �{.. S� �� Q`/��� fy(LI Q((C(�OY) Vo40.�G� <br /> 11 <br /> TYPE OF PERNIr(5): SINGLE-/FAMILY DWELLING ❑ ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE ❑ o _- <br /> BUNKHOUSE El 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ -f- <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: U� c R, <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: cdc N <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PNS o !t' <br /> IA <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. �' m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ° 9 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 'p <br /> AND INDICATE NORTH (N). c c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND(D) LOT DIMENSIONS. t7 'n <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES "1 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. R 1� <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. <br /> s <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN Cl <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O N) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n .� <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 <br /> SETBACK AREA. ► <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. s � � 0 00a tros'1 <br /> �, n m333A yyy <br /> I declare that this application(Induding any accompanying schedule)has been examined by me and to the best of my 3 0 g ° A <br /> knowledge and belief It Is true,correct and complete. I advrovdedge that I am responsible for the detail and accuracy of all n m e.e. e. <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this o E- > d to N <br /> Information I am providing will be relled upon by the County of like, Wisconsin in determining whether to issue a permit. I .°e ;, a w <br /> further accept all liability that may be a remit of the County of Burnett relying on this Information I am providing In this i., '�-"»n hd <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have `° n�P 3 8 8 0 , : <br /> access to the above-desvlbed any reasonable time far the purpose of Inspection. m a — 'A"moi.+ n <br /> F3n5 >Y88 � gg <br /> 6 <br /> OWNER'S SIGNATURE S l y ,I <br /> (date) g �,�. . F <br /> ZONING ADMINISTRATOR J10 F d n(iia n �,��� � �° 5 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED C)�' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> la c zyf�bki CUs ooa <br /> �-�> � <br />