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c A z <br /> Office of Zoning Administrator <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 g <br /> APPLICATION FOR LAND USE PERMITS <br /> y <br /> OWNER y TELEPHONE o n <br /> Llt/2FAlC� �IVOEI3� L ��1-� 33-7go$' e <br /> '/q A ' `. I d <br /> MAILING ADDRESS ,itgO J-7 i�, AV /�/ �/ IU�IU aRIGHTo�cl p1N $5112 V, <br /> 7 / (ytI <br /> PROPERTY ADDRESS <br /> 10-76 q Ckoss towlu 6'0 PAA)T5ey964 CUT <br /> LEGAL DESCRIPTION LDT 1 C5M Uol- 6 P& SI.c5 ISI -I - (,qO'T Lb73 <br /> ry, <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION r DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ I(I I <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING O CAMPING UNIT❑ w <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> m <br /> aTRUCTUR.E/.ADDITION USE: CA61AI - �^ z <br /> (Home/Cabiinn;/Commercial Business; Bedroom; Deck; etc.) ° <br /> BUILDING CONTRACTOR: bU1LD±lC5 <br /> n <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o_ <br /> WILL BE RETURNED. 60n 56 Uel, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C-f�"' " O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C d <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, i R <br /> AND INDICATE NORTH (N). c a <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES W <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i.. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REL•i0'v AL On CU7—imG OF TREES AND VEGETATION 15 RESTRICTED ALONG SHORELINE. ` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 7' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. � > o oo� > 0tros'1 <br /> n ,0333 RA <br /> R n a c c. _ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my o 6 S „ o 0 a, <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m = w'a <br /> Information contained In this application (Including any accompanying schedule)and I further declare that I recognize that this =. a a w `, <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I �' " =,W— : Y <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this - 'o ;,,y,' i N b <br /> application. I agree to permit county offlclals ch rged with administrating county ordinances or other authorized person to have O o o' 8 o t" <br /> access to the above-described Ise ason'ble Ime for the purpose of inspection. <br /> OWNER'S SIGNATURE S`=1,7-off <br /> (date) a P3 <br /> ZONING ADMINISTRATOR <br /> n C o. <br /> O w <br /> TOWNSHIP PERMITS MAY BE REQUIRED p <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF <br /> ISSUAN E <br /> tatk) rnaebe�mi � m � � <br /> to U O <br /> sada <br />