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C A p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER S.�o 7� TELEPHONE �7) ��� -321/, Q. k <br /> "CC �-yF' m <br /> MAILING ADDRESS /L�V Z G��O 4J Li(J -Sr...J i7JGf'FE:rT1�{"c //yJ/J 5/0 <br /> PROPERTY ADDRESS r!/./37 0 _ L\j ' <br /> o <br /> LEGAL DESCRIPTION r <br /> 0 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURES <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: <br /> . (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 1;7 ue1? `d,-7S7-l2GC CT'd mal 3 - SQV n <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER, ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. - y <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M <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, v <br /> AND INDICATE NORTH (N). N Y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) 0 0 <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w T Q <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. p <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. n rn <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 ' CCsy <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 y i <br /> NEEDED. L r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: :- <br /> �r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS.OF PERMIT. n Z <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. _ E <br /> 6. <br /> 7. �ra'fi Sef Al 95' Seth 6-�0-7 � � 'a 0 0 > ro <br /> g � 3 $ � <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 <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this a E.> >eo N <br /> Information I am providing will be relied upon by the County of Bumex Wisconsin in determining whether to Issue a permit. I .�y <br /> further accept all liability that may be a result of the County of Burned:relying on this Information I am providing In thisu_,» <br /> application. 1 agree to permR county officials charged with administrating county ordinances or other authorized person to have " n,°0 "': 8 o„r. <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. m S 5 W N w C] <br /> 8> . <br /> OWNER'S SIGNATURE a w 5$to n v,+ ro <br /> ZONING ADMINISTRATOR yrc� <br /> TOWNSHIP PERMITS MAY BE REQ D ZQ09 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM D OF ISSUANCEp <br /> N N S o' 18 8 <br /> O <br /> p�✓rvv�� } C�11eir,, ✓ 164 led 16 SCO.+&y �BURNETr COUNTY <br /> ,g ZONING <br />