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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 9 ° <br /> APPLICATION FOR LAND USE PERMITS N <br /> C?har 1e5 <br /> d-Arler y <br /> OWNERTELEPHONE a <br /> TOl�i�"1GCYlTI"uSt 9 Ga <br /> " o <br /> MAILING ADDRESS �5 I L4L^/ OILi I,k) &6 <br /> r 1015 LIS <br /> 15LIS Q--i, <br /> PROPERTY ADDRESS 614r0 <br /> Oo <br /> LEGAL DESCRIPTION o_ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 11 ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE p <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> A <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDI�T7ION ❑ COMMERCIAL(\ACCESSORY STRUCTURE ❑ � <br /> STRUCTURE/ADDITION USE: / rt\ o <br /> (Home/Cabin; Commercial Business; Bedroom; D4W, etc.) <br /> BUILDING CONTRACTOR: n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS F <br /> O <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m �y <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. �, g <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, .g <br /> AND INDICATE NORTH (N). <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 1 90 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. = N <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 E <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 — .-I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r O <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. 1 <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 ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> ^ = 9 n n n O D 0 7 <br /> 7 A 0 0 0 � a £ M <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the Lest of my <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained in this application(Including any accompanying schedule)and 1 further declare that I recognize that this a a a til, <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I ?w b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have d oo S : o o C' <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. `^ f1 <br /> y <br /> q- y � 0000 <br /> OWNER'S SIGNATURE C/�/�- �"`-r ' � `t�`� o s/ 6 0 d 0 r a, z <br /> (date) - <br /> ' - ' 'ra Fy3 r,1 <br /> qrc> <br /> ZONING ADMINISTRATOR S�m F10 I'Mt n TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N ti o U s <br /> 63-10-( -D <br />