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Burnett County 7410 County Road K, No, 102, Siren, WI 54872 Office of Zoning Administrator e- <br /> APPLICATION FOR LAND USE PERMITS w <br /> 4 N <br /> N <br /> OWNER /{(J / � /� �j _ -(. (� <br /> ` C�-t A ROD C-Q��L T TELEPHONE/ f L-(� (J 1 i '7 d p <br /> MAILING ADDRESS ---, 1S = O <br /> S It 13301 M l j w�� SSyo 1 <br /> PROPERTY ADDRESS p r'Y 5 m(` zQ` ��'��� <br /> LEGAL DESCRIPTION G 7, <br /> / 5 iu I`CflWtf� Ca NDnl17r�of o � �� <br /> TYPE OF PERMIT(S). SINGLE FAMILY DWELLING 0 AUDITION D DECK ❑ GARAGE/ACCESSORY STRUCTURE rn CIS <br /> BUNKHOUSE ❑ .59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ I (n <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ ` ^ <br /> /� o 7R <br /> STRUCTURE/ADDITION USE: A �� GF-- � c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: J <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 6 <br /> WILL BE RETURNED.DIRECTI <br /> m <br /> +f e <br /> ONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ^ o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, (� B <br /> AND INDICATE NORTH (N). '� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(5) (^ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK S' l <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 -\ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 9. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE c <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ° �J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y z O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. � annnnadro <br /> a <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my El c <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detall and accuracy of all c m F g.v <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that thls > D m ,�, <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I 'n = - Y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this P yo „ }„ ,, .rop <br /> application. I agree to perrnit county officials char d with ministrating county ordinances or other authorized erson to have c) ° ^• : o o r, <br /> access to the above-described prem s a y rea nage tl for the purpose of Inspection. p = o � <br /> OWNER'S SIGNATUREn 6 6 <br /> '7I t (date) W o � aEi <br /> 'o <br /> \lI� ��l(i1(QiRrl •1 <br /> ZONING ADMINISTRATOR <br /> IT <br /> TOWNSHIP PERMITS MAY BE REQUIRED O ^° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATEPF ISSUANCE =N <br /> �i�lu�, <br /> 4Lii/��L-�O(�" tnOOp Op <br />