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ro z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS " <br /> OWNERTELEPHONEC- 1r4/ 7 - 4//2 -3 *'d_ <br /> ( '// Y G'NATHfk/r nw.rlr s � <br /> MAILING ADDRESS JCI!qy ryt .Bou a C,( 1/ G O1113 <br /> PROPERTY ADDRESS 7 q r M J Q H,j G.A+ed <br /> Jam/ <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURES <br /> BUNKHOUSE ❑ 59.692(IV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ •-- <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDIRON ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> STRUCTURE/ADDITION USE: AA•R4tf .STvRR 4a/ a <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ©A G HS IaR o 6 <br /> n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 K X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE F PLOT PLANS o <br /> WILL BE RETURNED. O <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW wro <br /> BUILDINGS/STRUCTURES (NS), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O v <br /> AND INDICATE NORTH (N). 1V L <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (8) BUILDING(S) ta ° <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. 1 p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES Q.) h <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Oo y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE ` o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBTECT 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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. l <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. CU7J <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. SbrwCwe Eoiue > i/p Fcc6 Fon ct�fla,c( dS ale(rneclrzC by G 3W c(e <br /> 7. > o3 03 0° >d v <br /> I declare that this application(Including any aononparyi g d++d+o)has been examined by me and to the best of my 9 o <br /> knowledge and belief It Is tore,correct and complete I ac rowledge that I am responsil for the demR and accuracy of all <br /> Information contained In this application(Including any aomnpwTft sdhedule)and I further declare that I moogntte that this _ <br /> Information Tarn prcvtlirg vrO be reJed upon by the lbunhy of Burned Wisconsin len detanNuukg whether to Bnue a peed. I <br /> further acoept all liability that may be a result of the County of Bumett nelykg an this kdonnretlorr I am '� g <br /> application. I agree to permit county oMcharged with agh.0 IT county ordbauca or other aWerlad person to have <br /> amass to the above-deso6ed premises a an o���ti a for the purpose of k6yection. j <br /> googo > <br /> OWNER'S SIGNATURE <br /> 1 q (date) <br /> ZONING ADMINISTRATOR $SQL /'l• _ y �� 55 <br /> a rd � <br /> �° s <br /> TO SHIP PE ITS MAY BE REQUIRED 4 <br /> THIS PERMIT SH LL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U o w U o <br /> oovoo <br />