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� ^ o <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS = "' <br /> OWNER X LW E ravka.✓ \QIW FF Jd hk.S0ZPHONE (tla_ qaU 1.-jq�- <br /> MAILING ADDRESS /��/r /U✓ At._ <br /> AA. &-SN <br /> lQ <br /> PROPERTY ADDRESS a&a\ ' L 11 i-S I U�� � 6AC) IJP Y o <br /> C < <br /> LEGAL DESCRIPTION o <br /> TYPE OF PERMIT(S): NGLE-FAMILY DWELLING ADDITION DECK GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 59.692(I GAZEBO STAIRS FILLING/GRADING CAMPING UNIT --+. , <br /> COMMERCIAL BUILDING COMMERCIAL ADDITI N COMMERCIAL ACCESSORY STRUCTURE 3 <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: (i <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 00 2. <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW M b 9 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o. a <br /> AND INDICATE NORTH (N). J N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) 2 Op <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARKjp 1J <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES �y <br /> i <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 6O. P. w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE X, Ql 9 O <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 i y G `O <br /> NEEDED. y� r 4" <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O r C '�^ I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. -z (� z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ci w C <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 1J <br /> SETBACK AREA. G <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Ch <br /> NOT TO BE USED FOR HUMAN HABITATION. O <br /> 6. Pe✓0j14 aQPI.OUa-I I JLn T% i'�'�yl `ILdx` `ha" tD s �mud✓com adcl h6h a � <br /> -+back oFk<ti h ab Sho0v Or�drtwn. ,aod 54nT✓s an pasts Fiom ekks},r5 deck +o d e 7y a c a y <br /> 7. lake,no more If a 444'x�t7L AN i QIIDIA1I!G�.�0+-10I1 ,Xe IT 'fda 1. a try <br /> o <br /> I declare Mat this application(IrrdudhV any amompanytrq sdredule)has been eromkrd by me and to the best of my g <br /> knowledge and belief R Is true,correct and complete. I acknowledge Mam responsible I aresponsible Tor the detall and accuracy of all i ' <br /> IMmr <br /> oation contained In this application(including any aaoompmmdr <br /> rykq sdule)and I furdw declare that I reeogntze that this e a c t? y <br /> Information I am providing will be relld upon by Me County of Burnett Wisconsin In determining whatlrer W Issue a perrnR. I .°e " ? 5:,= :5 Iiy <br /> furdw accept all liability that may be a result of the County of Burned relying on this Mformation I am providing in this � � m <br /> application. I agree to permit county officials larged with adminkaratlr g county ordinances or other authorized person to have o S S 8 8 rw <br /> access to the above-desaibd et an tkne for Me inspection. a o g o g <br /> 0 <br /> L. <br /> OWNERS SIGNATURE D oil. o m n �y <br /> e3 6 `c0 <br /> o <br /> ZONING ADMINISTRATOR __ i E 00 <br /> BURNETI-COON n 5 <br /> OWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS P MIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N o u u <br /> Cer m l 4-.I-(M-ter ry-vlu-" f-ba 1�aq KtAfhtf4-5'1l1VJ0hr0dkl 9 li u 0 0 0 o s <br />