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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Adminl for -cp o <br /> APPLICATION FOR LAND USE PERMITS s �) <br /> OWNERI� k, ,Z E -S TELEPHONE 1-715 -2,51 -31 R <br /> u / IC / ,s\I IV <br /> MAILING ADDRESS 3 �� D Lock I, �'(�c'H-P® PPf kme <br /> sr <br /> PROPERTY ADDRESS 2 1/_q Loom Qom L� E hrjt,{/�„bL(,( <br /> J (Y 5ec4�oN of /hine.g1ST <br /> LEGAL DESCRIPTION o ' <br /> ce61Z - Lf2-01 - (72 000 TWA) QED PCL�FRL PAW y <br /> TYPE OF PERNIr(S): <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ RS ❑ <br /> „d <br /> FILLING/GRADIN/G ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ D K❑ <br /> STRUCTURE/ADDITION USE: � 4 S . z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ° <br /> BUILDING CONTRACTOR: fl fFU 0 CSL! P zP (UPPN <br /> CIO <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOTPLANS <br /> WILL BE RETURNED. V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 2 <br /> 8 <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 t <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) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARKp ,Bo <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),AND ALL DISTANCES o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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 g. i <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> y C� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION My BE DONE WHEN z: C> <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: j <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. z O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. `� Q <br /> 7. � g i <br /> 3w o05° 0 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> kno Judge C <br /> and belief it b true,correct and complete. I acknowledge that I am responsible for the detail and accuracy o/all Informs a E. <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognme that this Informs on I m ' <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further ac apt at g. • = 8 <br /> IIablity that may be■result of the County of Burnett relying on this Information I am providing In this applkatlon. I agree to <br /> permit aunty officials charged with administrating county ordinances or other authorWd person to have access to the abo e• ti <br /> described promises at any reasonable time for the purpose of Inspection. LA <br /> OWNER'S SIGNATURE /S l� '� G 'f:� Q � � o � V <br /> x <br /> I — date <br /> ZONING ADMINISTRATOR v�� �'a✓( ( /l - `�' <br /> Ll <br /> B <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> �I�(�����((C����Q/TT�QTT�(�'(�; <br /> TNTC DFDMTT CHAT I FYDTDF ANF VFAD FDl1M f1AT'F (SF GVIVIIYO`7UN <br /> ��rhi-- (JICked ttip C,- (3 off ltd v Shar�l� <br />