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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n o <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER1 (o tiSQ^ TELEPHONE <br /> Kevt; q92 -ZZ I _ 136CS <br /> . 1 t <br /> J o� <br /> MAILING ADDRESS 2020 Z .Ts'1 _/«AC�/K.L Ave- LA�fdy��r Nd $$'Oy'/ O F <br /> Gt ' i S <br /> PROPERTY ADDRESS <br /> 29606 olfaaaon o. , "k" LA-m 54Y$3o <br /> LEGAL DESCRIPTION O32, -5335- o$ - ooc�p _' c <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION JK STAIRS ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING❑ CAMPING UNIT 13 BUNKHO E ❑ <br /> ,59.692(IV)GAZEBO DEC ❑ <br /> STRUCTURE/ADDITION USE: 3 beAromms ' 4ba Jodfn <br /> h D/ �z �y <br /> (Home/Cabin; Commercial Business;Bedroom; Deck; etc.) S '� <br /> BUILDING CONTRACTOR: } (N <br /> 1�l <br /> O <br /> APLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT 01ANS +s y UJ <br /> WILL BE RETURNED. ON < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 2. o. U <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O lel <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) on <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK; C> a <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND A , AND(D) LOT DIMENSIONS. N y <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK AND DRAINFIELD(DF),AND ALL DISTANCES �. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. A (J,j <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 (J <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r1� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. . Y b <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n a p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (; 00 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C I <br /> SETBACK AREA. O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. I C <br /> NOT TO BE USED FOR HUMAN HABITATION. E O <br /> 6. <br /> 7. e fid SgkF2:WM0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know dge a Q C R <br /> and belief It k two,correct and complete. i acknowledge that I am X 2 M.. � � � � <br /> p g responsible for the detail and accuracy of all Information 0 2 <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Informs n 1 Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a perrniL I further acciept all d ^is W(" "�' <br /> liability that may be a result of the County of Burnet relying on this Information I am providing In this application. I agree to Ci'�^g "'`J^ 8 00 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o r1 <br /> described premises at any reasonable time r the purpose of Inspection. 21 y <br /> OWNER'S SIGNATURE <br /> 1! - (dabs) ' y S g <br /> R_. t•1 <br /> ZONING ADMINISTRATOR El 11 <br /> CT <br /> TOWNSHIP PERMITS MAY BE REQUIREDC?. Ls <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v C" o <br /> �+ I e 4er p i` Y-� R p ,b,-I 10 - 1(-t-o q a <br />