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Burnett County 7410 County Road K. No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITSa w <br /> -s <br /> OWNER ' <br /> <)\UQ r�[ L- TELEPHONE -aG � <br /> IA rV -76 3 y58 -13� <br /> MAILING ADDRESS ( S L Z f-YuL <br /> L✓'l C+ <br /> PROPERTY ADDRESS /A //) S y; G <br /> /VJr / o <br /> LEGAL DESCRIPTION <br /> L.3 <br /> Sic T'iON - 1R i w o <br /> TYPE OF PERNIT(S): SINGLE-FAMILY WELLING O ADDITION O DECK O GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE O 59.692(IV)GAZEBO O STAIRS O FILLING/GRADING O CAMPING UNIT O 5 <br /> COMMERCIAL BUILDINnG ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE O c <br /> STRUCTURE/ADDITION USE: r c�wwNEw"T O L E $ I� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) I Y <br /> BUILDING CONTRACTOR: /0 X �' , o <br /> n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN fl Vs X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> M I a <br /> i. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> a <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, e <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) c c <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. 00 <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. g, <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. ° Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN `C <br /> NEEDED. <br /> W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, ry i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. '3 z <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 �\ W <br /> SETBACK AREA. Iv\ <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. <br /> R i5 R333 �a 1� <br /> I declare that this application(Including any <br /> ac plemPa ing srheduk)has been aamined by me and to the best of my 3 ?.°2 u ? w <br /> knowledge and belief I k Lisa,carrell and complete. I admowledge that I am <br /> Information contained in this application(Including an carom n responsible detail and amaxy of ab m E;P-m y <br /> information I am ( nC Y pa ying sdedule)and I further dedare that I recognize that this '° c ° <br /> further a providing at a rbe a upon by the County of Burnett Wisconsin in determining whether to Issue a permit I d rs° > to <br /> sept all liability that may be a remit of the County of Burnett relying on this Information I am providing In this m 5'2 c 0° <br /> application. i agree to pemdt courtly oiRtlals charged with administrating county ordinances or atter autlrortzed � H "'69: s,^�' V <br /> access to the above-described Premises at arty reasonable time for the purpose of k�spedfon. Person W have 8 n,2 g g : 8 o t- <br /> m 5 T w C] <br /> OWNER'S SIGNATURE C � <br /> ZONING ADMINISTRATOR ° o^ya <br /> IWNSHIP PERMITS MAY BE REQUIRED F <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> JbI NNpN Ln H p�p <br /> 0 0 0 0 0 <br />