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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Ofte of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS <br /> 6 <br /> OWNER - 3 L � /1 I ITELEPHONE <br /> I> 6 <br /> o ` l,C�ro �n T, .�©� � <br /> MAILING ADDRESSL/. h r /\,l <br /> ` y S 4 Z�/ <br /> y8� 3 Silo" l )e� . I <br /> PROPERTY ADDRESS ,Tri <br /> LEGAL DESCRIPTIONG 1 �C OL/t f 7 T y O A/ K I E W , <br /> !- v c to <br /> SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE ADDITION ❑ STAIRS ❑ Q <br /> TYPE OF PBUI[T(5). ro <br /> FILLING/GRADING❑ CAMPING UNIT❑ BUNKHOUSE❑ 59.692(1V)GAZEBO ❑ DECK 0 <br /> I L' <br /> STRUCTURE/ADDITION USE: I�k ZtlJ/L/q0.r 'iG I.aJ 1 �1` $�Y'a`j e_ �O 1"' T'C.njWcrr�y r. o <br /> �^ <br /> (Home/ bin; Co mercial Business; Bedroom; Deck; etc.) R g <br /> BUILDING CONTRACTOR: Cc-II o6 f Ho.Me-5 -A ?9& / I (- <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vo X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS .� H <br /> WILL BE RETURNED. <br /> O 3. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) \ a <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). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) �' c <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Q ,a <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. v� z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C? c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE g. <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 WHENXL -qj <br /> NEEDED. O �. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <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 Ul <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. 57 <br /> 6. ' > > lw <br /> 7. .Za ` w <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained In this application(including any ato rnpanykg adneduie)and I further declare that I rewgnUe that this kdormatlan I : H-d <br /> am providing wig be relied upon by the County of Bui. Wisconsin In detan.Ining whether to Issue a permit. I further accept allg. r <br /> liability that may be a result of the County of Burrhett relying on this information I am providing m tins application. I agree to ^ M 8 u 8 <br /> permit county officials charged with administrating county ordinances or oder authorized person to have access to the above- B A <br /> desaibed promises at any reasonable tine for the purpose of inspection. mE mW M Y <br /> d �" d o r <br /> I P n / r <br /> OWNER'SSIGNATURE Il(>✓U ! �.J� X11 o/O 6 $ g, <br /> T1 r I 0/j tom/ (date) h: o, �, IT <br /> 0I <br /> ZONING ADMINISTRATOR v 1m -n( vl �h <br /> TOWNSHIP PERMITS MAY BE REQUIRED C� ^ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 0 -2 U o <br /> d- I e f-Fp,r mat pec! -f o 4 u h.e te64-\�f-. �-I� o� cy\ <br /> Catt b-Pt-he LOG,) LOJ HZ)✓r�j <br />