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C O <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning AdministratorDo <br /> g �_ <br /> APPLICATION FOR LAND USE PERMITS : F <br /> OWNER 1 • 11y, <br /> MAILING ADDRESS <br /> I � �' Dv,ry�( RiL CIeC�N�- � L�,nK �yv( f`1 <br /> PROPERTY ADDRESS v -L <br /> App -T'o Jo4 <2 VeLLAv� �- S <br /> LEGAL DESCRIPTION LDT <br /> TYPE OF PBWIT(S): SINGLE-FAMILY DWELLING v7 ADDITION DECK❑ ;E/ACCESSORY STRUCTURE ❑ g <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ S <br /> n <br /> 1 <br /> STRUCTURE/ADDITION USE: o b <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U� C� f0 <br /> BUILDING CONTRACTOR: vYV �1 co <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEQBLE PLOT PLANS <br /> WILL BE RETURNED. 0 ctz <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tn4 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW M 'O 3 <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, C) a <br /> AND INDICATE NORTH (N). ~ N o <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. O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES 3_ O <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. rn <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. —� I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE d <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 WHEN 77 <br /> r ..0U1 <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: r <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <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. RJ <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> a�n� ao e <br /> I dedae that This application(Including any aaoompanykq schedule)has been exwnk ad by me and to the best of my p A ? 2 g?a <br /> knowledge and belief K am responsible true,toted and Complete. I acknowledge that I arespaadble far the detail and acaraty of all C all —` <br /> t0 P_a. <br /> adorrnat on Contained Inthis appgcalbn(Including any a000mparyag schedule)and I f nt1wr declare that I recognize that this <br /> kdormatlon I am providing will be rolled upon by the County of Burnett Wisconsh indetwmbni g whelher tatae s permlt. I $ E n a <br /> further accept all liability that may be a reaWt of the County of Burnett rdylrg on this InformWon I am providing an this Q «N_ 88 . <br /> t" <br /> application. I agree to permit county officials charged with aduWdstraBng county ordinance;or of ho authorbad person to have o <br /> acus to the abwedaalbed IaerYsrs at=rea9wk*Wfor the Cf wNwn <br /> OWNERS SIGNA lJ(date) n H a <br /> ZONING ADMINISTRATOR J F`a nLG{C(n <br /> TOWNSHIP PERMITS MAY BE REQUIRED G <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Perm`,�� �ef+er pfekk?d k,0K-( HalleOAs-tvmHo zs ��a I �ug000g <br />