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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS N <br /> OWNER �rrod W { SIJ DUr�/ TELEPHONE <br /> a <br /> MAILING ADDRESS I ��V3 (l) <br /> PROPERTY ADDRESS c �I <br /> 16003 Glc^na� Z j <br /> LEGAL DESCRIPTION Yv `W b Se L S T3-?N R I I L'- / O <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION NT DECK ❑ GARAGE/ACCESSORY STRUCTURE 5 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: 10r� — '1--Y�-/�V�' y /` o o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> i <br /> BUILDING CONTRACTOR: n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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, a <br /> AND INDICATE NORTH (N). N c <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 w5 O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 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. W <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. N y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. ' <br /> Uj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> x <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. c� Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 1 <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. f <br /> 6. <br /> 7. z Z ,'Di c c o CI 9a 0 7 <br /> " n 8333 � 6� � <br /> I declare that this application(including any accompanying schedule has been examined by me and to the best of m S <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this 9 = > c m N <br /> Information 1 am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I •"e '' n �'- <br /> further accept all liability that may be a result of the County of aumett relying on this Information I am providing In this <br /> applicat <br /> time for the purpose of I <br /> access tlo the above-desalted prem dein rcro� a ordinances other authorized person to have <br /> reeto <br /> neopp oga <br /> nFli G o 0 0 0 H <br /> OWNER'S SIGNATURE �� G/O c yr > m n m = O <br /> I (d e) e 9oil <br /> 7' <br /> ZONING ADMINISTRATOR /'m �`�'�(" I`�/ I '5A p°t <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �ee <br /> 10 CUnS�'uchv o 0 0 0 <br /> Y m�1-� lel p(c�tec� �P 4 '5106 1 rsao <br />