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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> i <br /> 3 a 2 r U 2 W_)0 D - `-ATS--- J--------y— v <br /> MAILING ADDRESS <br /> -- _------- , Er ncn OL,e S ' � P U G /4r A! <br /> PROPERTY ADDRESS �/ '/9LS <br /> fE �y9 %Ho�filSon 1 l No SAwD lArA � <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION DECK AG EJACCESSORY STRUCTURE ✓ r�\ <br /> BUNKHOUSE 59.692(1V)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT - <br /> �d <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE s <br /> i <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabi ; Commercial Business; Bedroom; Deck; etc.) y _ <br /> BUILDING CONTRACTOR: ae 4IL .S -3 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS m <br /> WILL BE RETURNED. <br /> m I� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL OR TOP VIEW) m a <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 T <br /> BUILDINGS/STRUCTURES (NO), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O 1 v <br /> AND INDICATE NORTH (N). '„� , <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) p o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK � 1 `. <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. r =, <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES JM <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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. UI I U) o ) <br /> i <br /> NOTE: BUILDI G/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (fl .., L <br /> NEEDETHIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: - <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Iz N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C9 Is, iz <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 GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6, o- <br /> 7. n 78 D = n o > L'Trs7 <br /> R £ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the hest of my <br /> knowledge and belts it is true,carat and complete. I admowledge that I am responsible for the detail and accuracy of all E., -. wELs a <br /> information contained In this application(including any accompanying schedule)and I further declare that I recognize that this = > > <br /> Information I am upon by the County Burnett Wisconsin in detennintnp whether to issue a permit. I <br /> providing will be relied u c w= <br /> further accept all liability that may be a result of the County of Burnett relying on this infamatlon I am providing in this .� <br /> application. I agree to permit cou o1BcINs charged with administrating county ordinances a other authorized n to have c a c - = r <br /> access to the also p I at any reasonable time the purpose of Inspection. m j w <br /> OWNERS SIGNATURE <br /> (date) 7. <br /> ZONING ADMINISTRATOR_ _ _ "I = _° F IN <br /> OWNSHIP PE ITS MAY BE REQUIRED I } <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />