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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g <br /> APPLICATION FOR LAND USE PERMITS : <br /> OWNER f0.M'I PS 0An(Q/S TELEPHONE -yrs_ 8G 6 - 4/s7 - G <br /> ✓ v <br /> MAILING ADDRESS '� y <br /> Po. Y3.x �s � �,✓ � �� I <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> s. 3 *-Z 9 N I2/6W off- 3303 - 0/6 60 ! <br /> J c <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING;k ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ .� <br /> BUNKHOUSE ❑ 59.692(LV)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ U <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ y <br /> STRUCTURE/ADDITION USE: Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: .JaM B_r L ,*,l I e ` <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON AN B r/]X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. - <br /> T, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. f, <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 1 z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) �,OO <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 1 O <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 [, <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. v <br /> S. 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.,THEo <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 _ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: — <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r� z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. H <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 <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. EXis'Tl7V(i. NeX fro .4e_ yeloe6W 'b 2 75Ret {rva ONW.0 of Dew!'s <br /> 7. X)OSrfwG tfAA� Ge ✓e "W wrfhrw / Ye"" CrrwM*xaFdha New (lane > n o c o <br /> I declare that this application(including an accom an in schedule has been examined b me and to the best of m <br /> PP ( 9 Y P Y 9 ) Y Y 3 ? a , <br /> knowledge and belief It is[rue,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a � v E. = <br /> Informatlon contained In this applicatlon(Including any accompanying schedule)and I further declare that I recognize that this `-. > > F <br /> Infortnatlon 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I `-- .Dy <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this <br /> application. I agree to permlt county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. <br /> OWNER'S SIGNATURE I/ewr^�a �a"'"`�� `S X-S` / — <br /> (date) 2 Fo r <br /> ZONING ADMINISTRATOR �/ I m )(.7n7-{\ = v <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti N <br />