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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y: y <br /> OWNER Jom JA1J �Z.U�ESET�-k TELEPHONE 714 'n2- Zg`i3 t7 <br /> MAILING ADDRESS ° <br /> N 3Zp8 s4D'fi s i SET n{�p,�r�eiz Gi'N, UJ 1 Lqo N � <br /> PROPERTY ADDRESS 9P I oo 1` YE-u�. 1 twt 141 DAWBuax W( 94W � � � <br /> G77 t a C N <br /> LEGAL DESCRIPTIONl ' !Qe5 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING/A\ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ .. <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ 4 <br /> n' <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S <br /> STRUCTURE/ADDITION USE: 04, -� c <br /> ( me/Cabs ; Commercial siness; Bedroo , Deck; etc.) �\ <br /> BUILDING CONTRACTOR: <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 lh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> � 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW to o% 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH (N). 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 MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK 3' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <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. 0 rn <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 /> I � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN JQ ..I <br /> NEEDED. (n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z <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 \ Q <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. ^ ,y A 9no � G� 9 � � <br /> 0 0 0 N a li <br /> ° 6 <br /> 3 c '''a =. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 o oo <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all E. <br /> information contained In this application (including any accompanying schedule)and 1 further declare that I recognize that this `° E. D D m N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 5 g ii w <` i <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this i'r " <br /> application. I agree to permit county officials charged with administrating cgpnty ordinances or other authorized person to have <br /> access to the above-described premises at any r sonable tl for the pu se of inspection. / 3 D c o c c c <br /> OWNER'S SIGNATURE x > >; mn 5; <br /> (date) o g F, d <br /> � R . _. <br /> o <br /> ZONING ADMINISTRATOR O� H ', <br /> TOWNSHIP PERMITS MAY BE REQUIRED G °° <br /> THIS P RMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �, �, 00008 <br />