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Z <br /> Burrett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER I , / TELEPHONE <br /> MAIILN AG IDDRESS �?/_ / <br /> PROPERTY ADDRESS 3$�.f�r`�"'\V 1/ lN`V~��1•�� ���JI�AhA / W J�lI a \ <br /> LEGAL DESCRIPTION 11WT LOT- �S / 410r I p_I5vv Lo <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECKX GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE 11 59.692(IV)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> z <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ e � <br /> STRUCTURE/ADDITIONUSE: U. PL'6-c G �'sT/Nh nc eK = <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: n <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) p <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 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, y <br /> AND INDICATE NORTH (N). ? o <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. 1P 0 <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. ' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> lj) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. \ d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. Cy C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G a <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. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONI,1'. <br /> NOT TO BE USE FOR HUMAN HABIT'PON. n ^" \1 <br /> 6. cSC"h� t2+ S u/J /4!�^�� U�`Cnlc'cYc {�C.� E, 4 <br /> 7. <br /> 9 3 <br /> 2 0 c 'o'er <br /> 1 deEam Nat Nis applatlon(IrWuding any ornpl p. Ilrq sClMule)has been emmined by me and to Ne fiat . my <br /> latovdedge and btllef n k true,mrreR and compete. i acknowledge Nrt 1 am responslde far Ne debll and aaump d all <br /> :wWrnadmw I am Md dl g it be <br /> len upon by Una <br /> County accmof hung WIeco s in d IuMer detlare Nat I tla gm a p Nat Nis `--Dam_N <br /> In/annatlon i am PaNlity g will a relied upon by Ne xmn,a Bumex Wl roan on in determining whatlwr N issue a il,s, I <br /> haNer m. l all IIa w Nat man fie a dols daM CluntY'd mime W cau ty Nis vVorm m I am poWding In Nis <br /> appllmtlon. I agree m permtt munty olBtlals Narged wRh atlminlstratlrq county ardlnanar or oNer authalzed person to have <br /> a¢ess 0!Bre abavcdaalbed premisa M PY reasaude tlme lar the Paryme d IrtryeWon. %.6 a u N v u <br /> m o 00 <br /> OWNERS SIGNATURE �� �3 n y y 2' <br /> �: <br /> ZONING ADMINISTRATOR s/ 3 <br /> c g a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />