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Z <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator03 <br /> g <br /> APPLICATION FOR LAND USE PERMITS o <br /> OWNER rve-Het ) TELEPHONE �70 _2/li `7 <br /> 12�� d <br /> MAILING ADDRESS I wo s I" S-k osk5/oB&y 27,; S14-72 v( <br /> PROPERTY ADDRESS ; Y3 9,u)A y,fAh CRF2e V' <br /> LEGAL DESCRIPTION (' /y T/ v Iv �l y w /� .� 6,(A v <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION 19 DECK❑ GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: 3 xe( (.oh 7,,16'4Il,• '-, O,�_�=�. a j� <br /> � )(Home/Cabin;Commercial <br /> (1 Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: /IUWdl CY0111✓711;1> 2-2 -3071 <br /> /� <br /> / } <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) b~ f1 O <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, O c <br /> AND INDICATE NORTH(N). 2 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S) o <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S' <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 5 <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. n Do <br /> v, <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 -C c <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. I <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (vj� Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 6) n z * O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ;a <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (� <br /> SETBACK AREA. T' _(7,5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6 h aa ifior) rnu6�- lx > to' rfoon 54�Ce /off /lac, <br /> 7. a000 � a <br /> z � � � � ooa3 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this D <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m 5 c a v b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this �a 5 : ✓,; 6+„�^, b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to B. : o : 8 .0 <br /> have access to the above-described premises at any reasonable time for the purpose of inspection. S R 9 : »;4c+ (] <br /> m yooa <br /> OWNER'S rhe <br /> SIGNATUREQ/) � y, y m r,C; 4 „ O <br /> T (date) c : e E. E:. <br /> I � 'Z <br /> ZONING ADMINISTRATOR V m `an(qn �? c s n <br /> y <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM D TE OF ISSUANCE c <br /> Pe&rnf-d- fe41crma`led 4-6 /-)bwer,SiruzWtv ?-/6 -/0 �� go00 <br />