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r <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS w <br /> OWNER1� TELEPHONE - n <br /> fidd���,e' 1. LGCY ke.t 7is-4SL-yso� <br /> 5 <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS 3U S So P,wa. �tti S <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION DECK GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 59.692(IV)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT ,j <br /> 9 <br /> COMMERCIAL BUILDING 11(f COMMERCIAL ADDITION COMMERCIIAL ACCESSORY STRUCTURE _S � <br /> STRUCTURE/ADDITION USE: �Il. Jo2/ /L L o <br /> (Home/Cabin; Commercial Buslnes ; Bedroom; Deck; e�tc.11)` ( <br /> BUILDING CONTRACTOR: tt L D 70 µiCE93 <br /> ' 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V.X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS a o <br /> WILL BE RETURNED. TDj c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n o <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 dB <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, R 3 <br /> AND INDICATE NORTH (N). J N 1^ 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 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. ,J O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD(DF), AND ALL DISTANCES YJ <br /> 91 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. k 1 <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.,THE (� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r, y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: rr�yy <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS Of PERMIT. n Z V <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALIS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Q) <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. > ne na> �rs <br /> X � g3 'S'S � 2 <br /> Z 5 e - <br /> 1 detlam that be allf it is mhon ,ooma t, any ettvm I aq schedule) been responsible <br /> examined by meof r t and to the Dent of my o p R B ? �? 3 <br /> knowledge are talnel RIs bleep correct and complete.dingaI acknowledge that 1 ala responsible Tor the retch and aecurap of all 5.a S F o, <br /> Information cp m prod In Nis ill a mien uison by t any accompanying tMe4ple)and L determining <br /> declare h that 1 recognize that. I F' = > > s <br /> hdfurther a n I am pmility will a relied upon by tae ou ty W Burned Wying an Ins Information <br /> wh m Pr v Issuer pertnl[. 1 <br /> apple adept all ee top Nat may y officials resus ch Ne County aT Burnett relying ty MIs antes oro 1 am plevlding In MIs <br /> applkzoon. 1 agree de permit mustysatn Giarson wiN administrating county ordinances or otMr authorlxM person to have <br /> access m Ne aboveEesaihed premises a[any reasonable tlme for Me purpose or InspeRlon. <br /> OWNER'S SIGNATURE c '� > <br /> e � <br /> ZONING ADMINISTRATOR T <br /> oc -= ❑ F <br /> ✓ MAY 8 2014 w n ` b <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCPNETT COU o <br /> CUM ZONING <br />