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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 =; <br /> /� /�11Q fin <br /> OWNER CS on ,i-/�rr�kj!)(3r./,,d / TELEPHONE I � <br /> MAILING ADDRESS n I ' �1 a /S� �I /R y� cQ vi//n MA) 5 L//� �n <br /> J V /`V:�L (.(: /,/ L J <br /> PROPERTY ADDRESS <br /> ` ! <br /> LEGAL DESCRIPTION 1,r( 'J e !J / c fco' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ DDITION ❑ DECKK GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ a b <br /> COMMERCIAL BUILDING��❑ CO/ 1-1MMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE � <br /> 3 <br /> STRUCTURE/ADDITION USE: y-/'�--CIl.._ <br /> (Ho a/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS i c <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n 9J a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. e <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW I ,'- <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). j <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 G <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - .! <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �^ f <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE 77tO�I o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. , vll`.`A,,,\ 41 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. r7 z <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. x S d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER n <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. o > a t�+1 <br /> 3 _ _ <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 o p 2 2 a ? m <br /> knowledge and belief It is true,correct and complete, I acknowledge that I am responsible for the detail and accuracy of all 2 v <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this S.> > m ti ; <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I g `: m= ; .>o <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing In this z qig <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. (� <br /> ///j > ->•1 <br /> OWNER'S SIGNATURE t�VYlirf.F- !�/�'Gtl-L%✓L/ = a' <br /> T1 M n (date) 3 <br /> ZONING ADMINISTRATOR <br /> o a <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> b TCc� a <br /> +�eormi�°� 1et+��rce6u� PeCL <br />