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<br /> Burnett County 7410 County Road 14 No. 102, Siren,WI 54$72 Office of Zoning Admtnistrataren
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<br /> APPLICATION FOR .AND USE PERMITS cr
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<br /> OWNER �.– !!//
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<br /> TELEPHONE Il� , 3_I r� x a Cni
<br /> MAILING ADDRESS >~ -�
<br /> PROPERTY AODI>F55
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<br /> LEGAL DESCRIPTION Sow i - 4- e I
<br /> /64 Y b4 c•,..•c.44.- sec.. act -0 w s
<br /> TyP>=OF paHrr(S): SINGLE-FAMILY DWELLING CI ADDITION n. bECK 0 GARAGE/ACCESSORY STRUCTURE .7 r /;,1 .yi
<br /> BUNKHOUSE 0 59.692(Iv)GAZEBo 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT❑ L, 1+
<br /> COMMERCIAL BUILD0. COMMERCIAL ADDITION O COMMERgAI ACCESSORY STRUCTURE D i
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<br /> STRUCTURE/ADDITION USE; Z ` '
<br /> (Home/Cabin; Commarlal Business:Bedroom;Deck;etc.) P
<br /> BUILDING CONTRACTOR; �{ „G, ��, ("
<br /> 41 7
<br /> PLOT PLAN MUST BE P 'h�C
<br /> ROVIDED ON AN 8 X11 SHEET OF PAPfR, ANY TNCOMPEFi E CR ILLEGIBLE PLOT PLANS C o y
<br /> WILL BE RETURNED.
<br /> FOR PLOT N a
<br /> DIRP1.CTIALL REQUIRED DIMENSIONSP OR DISTANCES TO BEG: (ARIAL OR TOP 5 OWNN OR DRAWN TO SCALE. n a pp''
<br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW t
<br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES,STRUCT ..
<br /> AND INDICATE NORTH(N). b
<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 MARX
<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),
<br /> SCJ AND ALL DISTANCES C 1Z
<br /> TO BUILDINGS, ROADS,LAKE,LOT LINES, '
<br /> S. INDICATE IF A WALKOUT BASEMENT I5 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, n in 00 '�1
<br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THEo i
<br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. r;{�,
<br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST be STAKED SO AN ONSITE VERIFICATION MY BE BONE WHEN . JCi)
<br /> NEEDED. (--"J
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<br /> THIS PERMIT I5 SUBIECT TO ALL CONDITIONS LISTED BELOW: 1
<br /> `.'-- ,,b-.,.. 2 ,.
<br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r C
<br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C z 1 ( 1 O
<br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED.
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<br /> 4, NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THEv,
<br /> SETBACK AREA. REQUIRED WATER
<br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE'S IURAGE ONLY. [J
<br /> NOT TO BE USED FOR HUMAN HABITATION,
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<br /> 7. I
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<br /> I declare that this appIcatlon(indudIng any accompanying schedule)has been examined by me end to die best of my z•p e� g +� ri
<br /> knowledge and bendIt is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all B r6 g s ri
<br /> Information contained In this application(Including any ucoompanying sdledula)and LMUrher declare that I recognize that this o ata >m >
<br /> information I am providing will be relied upon by the County of Burnett Wlsainsin In dab:mining whether t a Issue a permit 1 e ." ir c .y
<br /> father wowan tablllty that may be a result of the County of Burnett relying On this Information I am'DroViding In this e h w Y a c
<br /> appllcadon. I agree to permit county Metals charged with administrating oral/clams or ether authorized person to have' o $
<br /> access to the abovrdesatbed premises at any reasonable_time for the pu of 4isp c a i, ti
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<br /> OWNER'S SIGNATURE �;:Gk O:yi r 4 E Z 2(data) 2 ! FOrent's•
<br /> ZONING ADMINISTRATOR mFlan �Gtr) $H01,,2 f; " rq 7f
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<br /> TOWNSHIP PERMITS MAY BE REQUIRED i ° E ".1
<br /> THIS PERMIT SHALL EXPIRE'ONE YEAR FROM DATE OF ISSUANCE 92uv,40i,o-
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<br /> P-e �� ma,:ied +0 i.e. e iatc,i ti, 7-30-�0
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