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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 3 <br /> APPLICATION FOR LAND USE PERMITS �') <br /> q�lA -VI/•fL �JO0 <br /> OWNER TELEPHONEmap lUVslenae <br /> MAILING ADDRESS <br /> (T <br /> \ <br /> a ^ v _I <br /> ado �o w�;- ,P� ✓Jali� y 263() Imo40 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION �. <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTUR <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLINGIGRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ OMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ s' v <br /> STRUCTURE/ADDITION USE: L� 4e .. <br /> < I <br /> (Home/Cabin; Comm al Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: <br /> n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o - <br /> WILL BE RETURNED. <br /> o � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <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, a <br /> AND INDICATE NORTH (N). e c <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 w' O <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 <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ti <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. 9-) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ,. <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS.OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i; <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 H <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7• T a e 553 e3 a a 0 b <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 ° ._.;,,v,?w <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all e, m �B.L p,a: ; y <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this rn N; <br /> Information I am providing will be relled upon by the County of Burnett W Lsmnsin in determining whether to Issue a permit. I .I ,'a w Si 'atl <br /> further accept all liability that may be a result of the County of Burnett retying on this Information I am providing in this °c ,,,;,,. �+,",, b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. [$ W N w n <br /> OWNER'S SIGNATURE a w 3 ni <br /> Ha�'.mngy,r0 <br /> c (date) <br /> ZONING ADMINISTRATOR o^ <br /> im <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> N N$O O O$ <br /> I��Yrn i`f �l e-�Fe/ T" �Gk2G+' it f� �i� ��i;✓�G� �TQmara <br /> t4 -lea -b `1 <br />