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ti v z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a ° <br /> APPLICATION FOR LAND USE PERMITS n <br /> OWNER IS- <br /> IDA VI f\ r� IF�LI TELEPHONE ��� _(/ZS- ��(� _ n <br /> MAILING ADDRESS l i5Z l V = J" <br /> moi✓ Y2 FALL [.c' SSLozZ c� ; <br /> PROPERTY ADDRESSo <br /> f 5 Z$ 44 OOdJ np E � J <br /> -7 > <br /> LEGAL DESCRIPTION rd <br /> TYPE OF PERMR(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ I rn <br /> 2 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL A DITIO ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c (p <br /> STRUCTURE/ADDITION USE: <br /> SCaB OA,/ 4oY / � ' �( a IJ � U z <br /> (Home/Cabins; Commercial Business; Bedroom; Deck; etc.) P � <br /> BUILDING CONTRACTOR: <br /> n <br /> o � <br /> A WILL BE RETURNED.PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <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. C <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, c <br /> AND INDICATE NORTH (N). z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) P <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.' i <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES Aj C? <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 ,` o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHENQ <br /> NEEDED. <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. `° J <br /> z 5 O <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 /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. ^ ryyannnna e <br /> A o 0 o N n til <br /> ry <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my3 ? 0 `� q q $? ,� <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a 2v = P <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this aa a s <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I _. R a <br /> further accept all liability that may be a result of the County of Burnett relying on this Information a WR-f�I@7��I o „ ; �„`.`- H N a <br /> access tlot I agree to permed county s at <br /> n charged with time <br /> for the pu county ordina to a h dl�e�oA/td hay f° ;?,off g o g g <br /> access to the above-described premises a[any reasonable time for the purpose of Inspe rl r"ni W 6 o W o o LR <br /> D <br /> �Q /� p 0 <br /> OWNER'S SIGNATURE VI"L <br /> nv, a � wn <br /> (aiptoa IU <br /> ZONING ADMINISTRATOR C.C� y ! T 5 o n <br /> �/ c m <br /> TOWNSHIP PERMITS MAY BE REQUIRED BUR ZONING A °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE H^ a a <br /> U In O O p C p <br />