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v t Z <br /> c � o <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator L.: <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> I / / _ �^ ^� O <br /> ii (1'1",A P/ �•J T/Ill r--�l���� TELEPHONE �J�' 7 /7 <br /> OWNER yy-� <br /> n <br /> O <br /> MAILING ADDRESS (J!7/ A, (�_/ , N <br /> PROPERlYADDRE55J/�7QI C30 o <br /> O Y O < <br /> LEGAL DESCRIPTION <br /> ,I <br /> Ler 3 CSM cal•1( p) 135, in <br /> 6w Lol Se{s�ur,+ J9, T�/ON le I <br /> TW, SCo7`r v <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE❑ a. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ ` <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: <br /> n (Ho bin mmercial Business; Bedroom; ck• cJ <br /> BUILDING CONTRACTOR: G (7 G W_.5.7g IJP" ri <br /> O 3 <br /> 77 < <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. cU <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 p 3 <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <br /> Q <br /> AND INDICATE NORTH (N). ?ZJ Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) ?Ll �. U 9 <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK p0 <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 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1- A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q N <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. AJON: Buddra 516,s Is roE ndrea6•.e -6e k n Eke. A of AXff I&66-a 444 aH <br /> /. Pam f.F-Burnet& C4wt,6y dAgoe Aas. I7, .2o*6 0g;f z X a o 0 0 o a o -0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m m m R ..J <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this E. D m i'c, : y <br /> information I am providing will be relied 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 officials charged with admstrating county ordinances or other authorized person to v o S o <br /> have access to the above- at any reasons a me for the pu f inspection. > -w N w n <br /> oo > <br /> OWNER'S SIGNATU <br /> ^ 4 O H <br /> (date) n 65 9'� m n v m 0 <br /> : <br /> 20NING ADMINISTRATOR 'f. ro 2Z 2 � g ;�: <br /> cw � Ois1 <br /> TO NSHIP PE ITS MAY BE REQUIRED H c <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE o . <br /> EN�N69 EA�p <br /> tJi vii O O O O O <br />