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L <br /> 3 I`, <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER WOOd IL(ACl HWAPSI�TIfG TELEPHONE <br /> MAILING ADDRESS <br /> 00. B .s T - <br /> OX HDA l >�om(n4 Mr- `aS 91 ; <br /> PROPERTY ADDRESS �O <_ <br /> 0 <br /> LEGAL DESCRIPTION r / <br /> o7L 4:t Vll�acy o F�i.�law � �� l7 r <br /> TYPE OF PERMIT(S): SIN -FAMILY DWELLING❑ ADD ON 0 ECK 0 GARAGE/ACCESSORY STRU RE <br /> BUNKHOUSE C 59.692(IV)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 V <br /> COMMERCIAL BUILDIN/G 0 CO(PERCIALADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 '- <br /> STRUCTURE/ADDMON USE: l..A'r ('()°-�' aLl <br /> (Home/Cabin;Commercial Busnen;Bedroom; Deck; etc.) <br />—BUILDING CONTRACTOR:-_-! - -- - - - - - --- - _ - <br /> z <_ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V.X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) el <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. CY <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(ES)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <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) <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS.. QJ <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, <br /> 5. INDICATE IF A WALKOUT BASEMENT I5 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE L^�' <br /> PUNS 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 SUWECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR OR SHOG LATREES AND VEGETATION O RESTRICTED ALONG SHORELINE. _- <br /> 3. NO GRADING ES SHOREUNG ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br />--� -4. NO STRUCTURES;INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER - - -SETBACK AREA. <br /> 5. ACCESSORY SED FOR HUMAN <br /> HA PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGIE ONLY. <br /> NOT TO BE USED FORHU 6e HABITATION. /� VNLW I/^C <br /> 6. s-f"I'u.c�"ttrC f6 b�Laufe..f to /HeG7 441 SQL.cr-F- <br /> 2. ✓�LLIeMo/�ff z > n n n c > Y T <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my -y o j <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of all a c- _ _ _ m -7 <br /> information contained in this application(including any accompanying schedu4)and Iforther declare that l recognize that his - > _�. ; <br /> infomutlon I am providing will be relied upon by Me county of Burnett Wisconsin in determining whether re issue a Permit l = � — <br /> fortheracceptallliabilityMat may baa rex It of the Coun rnett relying on this information l am providing in His _ m' 5 �— N <br /> application. I agree to permitiounty M bcM1a rl admi i[ra g my ordinances or other auHoriaed person to _ �' - = - c' <br /> have access H Me above-de bed emizez at ble ' e fo e p x of inspection. v 6 n it N u (] <br /> �r <br /> OWNER'S SIGNATURE y wle rc ' n - <br /> A/ (date) <br /> ZONING ADMINISTRATOR �/ r� ' Z : <br /> _ P-2-6-2013- _ o T <br /> x � <br /> TOWNSHIP PERMITS MAY BE REQUIRED C) <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF 1556AIMETT COUNTY u, T <br /> ZONING <br /> \ � — _ - - <br />