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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n z <br /> APPLICATION FOR LAND USE PERMITS C/ J <br /> a <br /> OWNER TELEPHONE <br /> � TELEPHONE <br /> 5L O V53U <br /> MAILING ADDRESS Sine),) L lS 5- / a' <br /> d� lXyXJ1 <br /> O <br /> PROPERTY ADDRESS ( C <br /> Read _ J <br /> LEGAL DESCRIPTION _C)f I/I �0 r7 `1 n <br /> SINGLE FAMILY DWELLING 1I IGARAGE/ACC S Y oU'CTU/RE ❑ ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 13—CAMPING UNIT ❑ BUNKHOUSE 13 59.692(1V)GAZEBOI11 <br /> y/oDECK <br /> �p❑ <br /> STRUCTURE/ADDITIONUSE: Jp <br /> o—�oabi�mercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: Se-17— � <br /> � <br /> W <br /> I�J C <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS .n � <br /> WILL BE RETURNED. <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 <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 m <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDANG(S) �J c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK' v <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. N ti <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. CJO <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W �' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z O i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n 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 /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGEISTORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. E <br /> 6. <br /> a7. <br /> ' �mQ� � <br /> e <br /> I dedare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge Z,ti y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relled upon by the County of Burned Wisconsin in determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the County of Burned relying on this information I am providing In this application. I agree to <br /> permit county oMdals charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for Na purpose of I n. <br /> o coq $ x <br /> (date) <br /> r w tm <br /> ZONING ADMINISTRATOR S <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE r w 8 U o <br /> v, <br />