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07/10/2007 08:55 3492166 B C ZONING PAGE 01 <br /> ON COMPUTER/SCANNED <br /> Burnett County 7410 County Road K, No, lOZ, Siren, WI 54872 Office of Zoning Administrator c A e <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER KklA00 R�,I�I( �IUEhS TELEPHONE Les _-17D _g a'� a W <br /> W <br /> MAILING ADDRESS J <br /> 5 i0 SLPZANPye Avtc 5NGR6y) 6w , Mw 551' <br /> PROPERTY ADDRESS aglO C) J L.ONLv �,RI[C—. �aNtL �ANgVA'�( J�DJv <br /> LEGAL DESCRIPTION �n O <br /> SINGLE FAMILY DWELLING D GARAGE/ACCESSORY STRUCTURE D ADDITIONX STAIRS D g <br /> TYPE OF PERMIT(S): g- <br /> FiLLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE❑ 59.692(IV)GAZEBO❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: �1p I rU Wdl +(ayi [U K '�O <br /> (Home a I Commercial Business; Bedroom; Deck; etc.) <br /> M� No ctdd,f bedroo�1 � ' <br /> BUILDING CONTRACTOR: yJ 0 <br /> Ir 0nl <br /> A PLOT PUN MUST BE PROVIDED ON AN a Vi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS „h <br /> WILL BE RETURNED. c <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AitIAL OR TOP VIEW) s "g <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tnn <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW c <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECK$, PORCHES AND OTHER STRUCTURES, p'�O <br /> AND INDICATE NORTH (N). I <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 MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK I <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(0) LOT DIMENSIONS. N u <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (OF), AND ALL DISTANCES o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. M <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O c <br /> 6. IF SEPARATE PIANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER, CONTRACTOR, ETC.,THE a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. A (u <br /> NOTE: BViLDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW:. W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 15 RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I_ A) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA, W <br /> 5. ACCESSORY 5TRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. S `l <br /> 6. <br /> GpNot d <br /> 7. <br /> to <br /> 1 declare that MIS application a d compleing any accompanying schedule)has been examined d to me and to the best M my rInformation <br /> knowledge k 7 <br /> and belle(It Is true,correct end complete. f acknowledge that[am responsible for the detail and accuracy or oil In/ormetlan <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I S iya <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <br /> liability that may be b($suit of the County of Burnett relying on this Information I em providing In this application. I agree to $ �^ <br /> permit county omclala charged with ad ratnq county ordinances or other authorized person to have access to the above- S n <br /> described premises at any reasonable <br /> hn ar th Durpose o/Insplttlon, m m -T.. <br /> �gc=� <br /> -7 vz RRA _ B <br /> OWNER'S SIGNATUREav` o n sy e. Z <br /> (date) pec_ y a R > , <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> artNH <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> ril"i ( L L� � Lz ✓ Qac d �p 6,112�,) 6ive�J It -D <br />