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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS = G <br /> &/2 - izlo-4/00 days <br /> �- Sho w <br /> OWNER TELEPHONE - <br /> /i/// CS nOCr50 /�/L- G,2/S3G�<llS 2.vE <br /> MAILINGADDRESS <,n Oeo-DO�(5 <br /> PROPERTY ADDRESS 29a-Q NLk,k, RSJ, CO/..//�� 79—u/75/2,(J I \ <br /> LEGAL DESCRIPTION L07$ Shores / <br /> TYPE OF PER0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 ,2 <br /> COMMERCIAL BUILDING U COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> / I 3 <br /> STRUCTURE/ADDITION USE: -Home /C in � c <br /> (Home/Cabi//n'�; CommerciallBBusiness; Bedroom; Deck etc.) <br /> BUILDING CONTRACTOR: L�Q/C Com�anrr%s «' <br /> r. ( <br /> m � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS F g _ <br /> WILL BE RETURNED. <br /> n <br /> DIREFOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL c 'J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR <br /> S/DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND B), OF ALL EXISTING , PORCHES AND O TURES (EB)AND ALL NEW '+ " <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). IN <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ° p <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHW M)OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND GRAINFIELD (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. y <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. H <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> (J� <br /> THIS PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, r y Ui <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a 1 <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> '— -- 4. NO STRUCRJRCS,-INCLUDING RETAINING WALLS, ETC.`ALLO'JJED VVITHIN 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. f <br /> 6. � pano nn > ov <br /> Y-2S(-itrT'T'7 R n ^ 3 3 m <br /> as 3 ' 7o'cw � <br /> I declare that this application ,correct any accompanying acknowledge <br /> schedule)has been examined of r t and to[M1e best of my 3 d. =. =. <br /> Information <br /> and belief It Is his application correct ani complete. I acknowledge Mat I am responsl6le for Me detail ani accuracy of all g. m = = = <br /> Information contained In MIs illbe upon by any urt,accompanying schedut Wisconsin <br /> and 1 hotherdetermining <br /> ng declare Mather I recoena p that this <br /> Information 1 am provlity will a be a upon of Me County of Burnett Wisconsin In determining I am pr to Issue a permit. 1 <br /> furMer adept all ea61oty Mat may county <br /> officials result ch rg County of Burnett relying county <br /> this Information 1 r a providing In this <br /> application. I agree to permit countyesat <br /> any <br /> ble time <br /> for the purpose <br /> munry ordinances or other auMorixed Gerson to have t a =¢ �_ r <br /> access M Me above-described premises at any reasonaM1le Time for Me purpose of Inspection. m <br /> 6 <br /> o <br /> d 8 oo oN ..i <br /> OWNER'S SIGNATURE a'c oG _. O <br /> (date) - 'F 3 S - -- <br /> ZONING ADMINISTRATOR y ? m <br /> TOWNSHIP RMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />