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r <br /> ' Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator � 9 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER <br /> /?01' ,0.✓D ✓L11Jr/ $A/jj ry�/ J TELEPHONE J, 18 393- 9573 <br /> MAILING ADDRESS a16 2S /ZtO OAAG X12; J� <br /> Y <br /> PROPERTY ADDRESS SAMA <br /> o <br /> LEGAL DESCRIPTION <br /> 5 E 9tTfILf/E 1'7 r <br /> TYPE Of VERMIT(5): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 ARAG ACCESSORY STRUCTUR19ki ? <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 d' <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCE55ORY STRUCTURE❑ <br /> r 3 <br /> STRUCTURE/ADDITION USE: flDn/06 J� <br /> (Name/Cabin;Commensal Business; Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: SELF a <br /> O <br /> s <br /> m l] <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'/z X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS m <br /> WILL BE RETURNED. < <br /> m - <br /> DIRECTIONSFORPLOTPLANDRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <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, <br /> AND INDICATE NORTH (N). N m O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,NH BUILDING(S) <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK - a� <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. as {2 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES p� <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. _ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE m -i -Z- <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. F <br /> 6 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SU61EU TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. F <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 15 RESTRICTED ALONG SHORELINE. d Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ip <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Cy <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY Q <br /> NOT TO BE U(SED FOR HUMAN HABITATION <br /> 6. NCd, <br /> ° V/IU, {� l,�a/��1 LCse 13J9 <br /> 7. <br /> 3330 <br /> knodareeand belief itist application ancomplete.ng any Iacknowledng e)hat I am examinetlbyme and le r thedtathe and best accuracy <br /> 3a R m' 3 <br /> information <br /> and belief it thise,carmt[anticludin[any acknowledge schedule) <br /> andI furthermeare thtIrecognize of that <br /> m ` u' d'a y <br /> information I amproviding <br /> rovinhhisapplicationuponby tanyaccompanyingschedule)antlItermerng whethat1recognizethat.his <br /> information I am pabilit t will a relied upon of h e County f Burnett <br /> Wisconsin in Information <br /> whether pr to issue a permit [ <br /> furthera¢eptall liability[M1a[maybearesult af the County of Burnett relying on this ln(ormationlam prvvitling in this Ie5 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person t <br /> have access to the above-tlescri asonable time far the purpose of ins > ' <br /> 1p3�1 1r m o > <br /> OWNER'S SIGNATUR <br /> I mce >'smn0 - - c <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQED COUNTY a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE ljy` <br />