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Burrett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator b z <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER E(j +[k)a��� ^I TELEPHO �� ,/ toCJ <br /> NE-7&3_ �_ZO <br /> MAILING ADDRESS 323 �� JI��� •1 C I I 1 M� 55�Y S <br /> PROPERTY ADDRESS 595"1 I�� LcLrte, t�rf� l �kbs-�-r� IiJ � w <br /> LEGAL DESCRIPTIO LD 3 O CSM olurYiib i GOVeanmen 3 �, CK) <br /> ergo n 264'ioI(mShip 3q, a"1A-) 1 U <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORYSTRUgrURED ADDITION 0 STAIRS 0 0 9. <br /> TYPE OF PERMIT(S): �( ,9 <br /> FILLING/GRADING�7 CA'M/PING UNIT 0 BUNKHOUSE 0 59.692(1V)GAZEBO 0 DECK PL <br /> STRUCTURE/ADDITION USE: - _ EecY) 8' -L24 , <br /> y c(Hom (Cabin; Commercial Business; Bedroom. Deck; etc.) ,L <br /> BUILDING CONTRACTOR: .� `I o7 1 Jok,4.5 , �1,627— N l l!( La l' <br /> tis-X35 -�,9bS �j�IegD w1 54666 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 SHEET OF PAPER, ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS y <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLM PLAN DRAINMG: (ARWLOR TOP VIEW c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALL°. t� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXI5TDPG.MOMUW60SYRUCPJRES(EB)AND ALL NEW , <br /> isUILDINGS/STRUCTURM(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCRIR6, to <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUBDING(S)TO ALL LOT LINES, (B) BUILDINGIS) o <br /> 'PO 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. y z <br /> 4. THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND AUcL116TANCES P <br /> TO BUILDING,ROADS, LAKE,LOT L.INE9. <br /> 5, INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p O <br /> b. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE p <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> H <br /> NOTE: ARE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN w <br /> HEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Cry <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. y C� <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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. I Q <br /> 6. <br /> 7. <br /> aim 6c?y <br /> I declare that this application(Including any accompanying schedule)has been annninod by me and to the beet of my knowledge Q <br /> and ba1Nf It Istrue,correct and complete, I acknowledge Out I am responsible for Me detail and accuracy or all Information P <br /> a. <br /> contained in Oft application(Including any accompanying schedule)and I NrNer declare that I remgmMInformation ze at this I F <br /> am providing will be raped upon by the County of Burnett Wisconsin In determining whether to Iowa a parmIL I further accept aL • r��T2 k3 N$ �! <br /> liability that may be a result of the County of Burnett relying w this InromNtlon I am providing in this application. i agree to "q g <br /> permit county oTcleb chadMad w ministrating county ordinances or other authorized person to haw access to the above- S rA <br /> described Premises atan, I tlm the purpose of impaction. �° _ „ O P 2Y <br /> OWNER'S SIGNATURE <br /> (data) fie : IO 8$ <br /> ZONING ADMINISTRATOR <br /> ern t e <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> y H: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE p g lg <br /> flwr-� 44 Ivl'! � Vhailee� tv ���o��cs �;e s-a�cog <br />