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C ° O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> 5 <br /> OWNER ty 0.r TELEPHONE <br /> 1 t m <br /> MAILING ADDRESS II,rII 6�a�S IQ114t A/i�I <br /> PROPERTY ADDRESS / c`�` 1 l IS <br /> -703-T Ra;Ac,,w lsv,e Y4.blJc / , VvL o <br /> l < <br /> LEGAL DESCRIPTION �IoT a _�Rai n d ouJ ) L a� o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION 0, DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> ro <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE o � <br /> STRUCTURE/ADDITION USE: Bec1 Ilan r� Gld�cTl M our bUknkkoos Q., , <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ° <br /> B LEJING CONTRACTOR: ti T + n <br /> .-h r 6e v r 41%, La� � <br /> yr o <br /> A kOT PLAN MUST BEP OVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY rMCOMPLETE OR ILLEGIB&PLOT PLANS O o <br /> WILLBE 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. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW to ro 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, - F <br /> AND INDICATE NORTH (N). n, p <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 <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. ^ v. <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 E <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUB3ECT TO ALL CONDITIONS LISTED BELOW: n) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. f7 Y JCJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. !n <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. ^ � >000 _a',� tbs'1 <br /> yzo � Aoa= <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 c = F_a <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this v E.9 n m N <br /> Information I am providing will be roiled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I ."e 6,°^, ?w v : > <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this a ° .n N: 8 N f. <br /> 'd <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have $ $ <br /> access to the above-describ5p �s at any reasonable time for the purpo of Inspecti �(a00 H� fDawn mroo <br /> OWNER'S SIGNATURE _/ _a nsn co.°2 6 B 'X(date) o. 5ZONING ADMINISTRATO <br /> p a <br /> TOWNSHIP PERMITS MAY BE REQUIRED A �' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N N N o <br /> ,n v, $ 0000 <br />