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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g' 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> _ <br /> OWNER C^� w,f \ O CICS TELEP-J��O E� i/— 0 <br /> (7 <br /> MAILING ADDRESS PO f10 X /a s- I <br /> C <br /> PROPERTY ADDRESS 63a A/r?UF /"4/ o � <br /> I U1r'B9T�'R <br /> LEGAL DESCRIPTION S�`c�7�'c.02.E' T'owti�siP 3q Ra<c.�t;E i� Oo <br /> TYPE OF PERMIT(S): SINGLE FAMILY DWELLING Ir GARAGE/ACCESSORY STRUCTURE Iff ADDITION ❑ STAIRS ❑ I� 5 <br /> FILLING/GRADING❑ CAMPING UNIT❑ BUNKHOUSE❑ 59.692(1V)GAZEBO❑ DECK @' <br /> STRUCTURE/ADDITION USE: C S <br /> (Home/Cabin; Com--meerccial Business; Bedroom; Deck; etc.) c <br /> BUILDING CONTRACTOR:_�41 b(tWER Zecc/p/t Ae-7— <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED, b o <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING_BUILD[NGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRU <br /> CTU B), INCLUMUZECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NO (N). —� ^ \ o0 <br /> 3. SHOW DIMENSIONS OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES,(B)BUILOING(5) <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. - w' <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 /> S. INDICATE IF A WALKOUT BASEMENT I5 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. F <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER, CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. r,;1 <br /> NOTE: BUILAING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN k) <br /> NOTE: <br /> NEEDED. ; <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 6 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. nr <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ri <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. z <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER a <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GAMGE/STORAGE ONLY. <br /> NOT TO BE USED FORRHHUMAJ$HABITATION. P , y V/B [X <br /> O fl <br /> 6. �1 l' -�IcaCl.1�JCu�r ft7U.tj <br /> �, F` L <br /> 7. F a �e lcipmo j,'+*4- f <br /> l declare that this application(including any accompanying schedule)has been aamined by me and to the beat of my knowledge Sn <br /> and belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of an Information R " A 9 g$_ <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether bo Issue a permit I further accept all y R <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to <br /> permit county officials charged with administrating county ordinninces or other authorized person to have access to the above- $ v <br /> described premises at any reasonable time the purpose n. <br /> OWNER'S SIGNATU "'�D b °' <br /> - „ n <br /> (date) <br /> A 0 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> + A ��/�,�� �p <br /> I L.r rr t( 1 �V1 1 N(C�i(� (/� ��% �W' • `i/lt I Jbh'e S v�N VVViNO <br /> / 14 -10- 6g <br />