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C A O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c <br /> APPLICATION FOR LAND USE PERMITS H <br /> 0 <br /> 763 -3Gz' - `18/? <br /> OWNERS TELEPHONE <br /> r✓2.c isnEL .¢ a'- .RENEE� <br /> MAILING ADDRESS n <br /> 5626 LiiVJSN-�J ST 6os '> {/i$LLGy /'J'✓�V S,S `/.22 "� <br /> PROPERTY ADDRESS PP7'�/%SoM �U lric65TG/2 r.(/I S- �/gy3 0 <br /> LEGAL DESCRIPTION LOT // CS/�'f ✓.IO P.200 C xr37D 6,F <br /> (PRT Csrn ✓,to N4✓ i/•1 ) <br /> TYPE of PEPERMTr(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ 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 ❑ a <br /> STRUCTURE/ADDITION USE: <br /> (Homme/Cabin; Commercial Business; Bedroom; Deck; etc.) (— <br /> BUILDINGCONTRACIOR: —/+LL/`Sv'/ <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c . <br /> WILL BE RETURNED. <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) er Ci d <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 R7 ° 3 <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) BUILDINGS) ! n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S 0 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. d <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES q O� <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES, N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 4J (A <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE £ W <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> Ci <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y �' <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, rl C�C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. !n J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I^ <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. Cr <br /> 7. s c tM <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my g o <br /> knowledge and belief It Is true,correct and complete. I admowledge that I am responsible for the detail and accuracy of all E E-I- <br /> Information <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this 19 e,> > W y <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this ' c v. <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. ° 8 14 <br /> 1M,"� .lf, mn Fa a88 o88 r> ., <br /> OWNER'S SIGNATURES� _,4eev_-P— -e, LXJ.I'�Q (date) c y P, 5i 2, <br /> ZONING ADMINISTRATOR'S tain tgf A n <br /> C >' m <br /> TOWNSHIP PERMITS MAY BE REQUIRED O: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U o 0 0 8 <br /> tPerm4d <br />