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n z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator i PCA <br /> APPLICATION �7FOR 1LA"ND USE PERMITS <br /> OWNER S�"E'-V2u1 a,tA LvJc' JVe✓\�`c '� TELEPHONE --�)� c�_3� 3 d <br /> MAILING ADDRESSLe 0 lb'C- Gra_r+SLL .) LRS ( 'Jt-I�yn <br /> PROPERTYADDRESS a_yr_j(.0C7 <br /> LEGAL DESCRIPTION d <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> 9 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORYSTRUCTURE ❑ o S <br /> STRUCTURE/ADDITION USE: J�Oru. <br /> (Home/Cabin; ConTimerdal Business; Bedroom; D ck11; etc.) <br /> BUILDING CONTRACTOR: V t W'P k f e' po vM d n <br /> � � C <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M 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 to b 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). c c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w p <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. O_ 4- <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE (b <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. S 0) <br /> NOTE: BUILDING/STRUCfURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ti <br /> NEEDED. r p 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: QQ w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z <br /> ci <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B p <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 ` d <br /> SETBACK AREA. \\1` <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> g7d >OOe > oro <br /> n e�hJ <br /> 7. F '2, aanSS3 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my o Z 2F„_= �; <br /> w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all o.`�m P "E.a <br /> Information contained In this application(including any accompanying schedule)and I further declare that I remgnlze that this " c m N: > <br /> Burnett 1 am providing will be relied upon by the County of Buett Wisconsin In determining whether to issue a permit. I $ °'y M w z: rs ro <br /> further accept all liability that may be a result of the County of Burnett retying on this Information I am providing In thisc (J�c H N: <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have a Ia §8 <br /> access to the above-described remises at an reasonable U for the purpose of Inspection. Ia j5 Nin <br /> p YY pg > <br /> OWNER'S SIGNATURE--SO" k <br /> (d te) <br /> ZONING ADMINISTRATOR <br /> ^P : <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N 8 0 0 0 8 <br /> t4010Y h�,. 6Veh L e' <br /> q-8-&3 <br />