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C p <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> G <br /> 6 <br /> OWNER � 4-Dp6W� TELEPHONE GK�.. e/ 6 <br /> I` 0 ! 0 <br /> MAILING ADDRESS ./ I .. O <br /> S d S`/ / 61nex Iry Ll <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION oS m v, <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 13 STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ C�q_M1ME�C�IAL ADDITION ❑ �ICOMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> STRUCTURE/ADDITION USE: /-1'IY (! i � � til.- /.`. Ur �C- ��i�''�' �— o <br /> (Home Cabin* Commercial Business; Bedroom; beck; etc.) <br /> ACTOR: i , 1 <br /> BUILDING CONTRr) <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ih X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW p7 w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, o <br /> AND INDICATE NORTH (N). N z <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 5. <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 5. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. " w <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN �I 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. N <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, p7 > > <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my g o 6 . . . C ? w' y <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all y m' v' 'm' a ! y <br /> Information contained in this application (Including any accompanying schedule)and I further declare that I recognize that this 5.5 D m N : a <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I m a a a= <br /> w <br /> further accept all liability that may be a esul[of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county o lals charged Ith administrating county ordinances or other authoriz d person to ' O <br /> have access to the above-describepr ices at an re nable time for the purpose of Inspection. m > w N w (] <br /> OWNER'S SIGNATURE G(..� d 3 A oa o o g o y <br /> rt n <br /> (date) us n cCO E c 2 <br /> .n+�vy'� <br /> � <br /> ZONING ADMINISTRATOR 1 (Y1- Jc�61 `= O�. g n'n�. : y Q0 [n <br /> V1� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a <br /> Vto O O O O O <br />