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Burnett County 7410 County Road K, No. 102 Siren WI 54872 Officem <br /> of Zoning Administrator b z <br /> APPLICATION FOR LAND USE PERMITS g <br /> M <br /> OWNER Sh�� tnse-I TELEPHONE 651 <br /> CJr) DJ m <br /> 8 <br /> MAILING ADDRESS r .. <br /> S�or ;ev /1t..( SIZb , <br /> PROPERTY ADDRESS %J Aq !�QDnneg � n <br /> bb YCo 7 O ' <br /> LEGAL DESCRIPTION S24 <br /> 7p}(J lR 15W 4rr C xiv VW-t3 <br /> TYPE OF PERMIT(S): <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ST RS ❑ o <br /> _ .. <br /> FILLING/GRADING ❑ CAMPING UNIT 9f/BUNKHOUSE 111 59.692(1V)GAZEBO ❑ DE K ❑ W <br /> STRUCTURE/ADDITION USE: z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: h1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT LANS r) <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � -0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T p� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW '�G <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, to <br /> AND INDICATE NORTH (N). ..� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILD G(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 3 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. ' <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD(DF), AND ALL DISTANCES N J o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 c O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE 5; <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 6. <br /> y 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE HEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O . ) <br /> C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z J n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. " W <br /> n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. H � <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. <br /> 7. iS n $ � m2 cE t2s7 <br /> �. 00'O c 5- c,-, <br /> I detlaro that this appllwtlon(Induding any accompanying schedule)has been examined by me and to me best of my knowledge <br /> and bellet K Ls true,correct and complete. 1 admowkadge that 1 am responsible for the detail and aaurecy of all Information <br /> contalnetl in this applimtlon(Including any acoompanying schedule)and I further declare that Ig <br /> reoognlze that this inforrnatlo I iv Y <br /> am providing will be rolled upon by the County of Burnett Wisconsin In determining whether to Issue a permR. I further accel t all g. H N='W g b <br /> liability that may be a result of the County of Burnett rolying on this infomratlon I am providing In this appliwtlon. I agree to <br /> perrnR county ofBdals dwrged with administrating county ordinances or other a orized person to have aaess to the above o f1 <br /> described Dremises at any reasonable time r the pYr ose of inspection. / <br /> OR,uo ��r� <br /> Q lI m lJ).^ `d � <br /> OWNER'S SIGNATU /JA g'� F C)a 0 <br /> e - <br /> � ' <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERM MAY BE R ED JUN 1 1 2001 5 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM E OF IS u 8 U o <br /> P lei I�� 0-a&d 4.0 �f�ie�suI �r�'�u"��r�6 �� <br />