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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator = 1 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER (�( l—1 _ TELEPHONE <br /> ..jjo.J�- ter 7 3`a5-�sw '}l�l7n(a <br /> /Y MAILING ADDRESS <br /> 17 <br /> "'PROPERTY ADDRESS �^ -_- ^ c '= <br /> X LEGAL DESCRIPTION <br /> TYPE OF PERMR(i): SINGLE-FAMILY DWELLING❑ ADDITION,* DEC/KV❑Y`GARAIGVVE/IIACCESSORY STRUCTURE❑ = n <br /> BUNKHOUSEC) 59.692(1V)GAZEBO O STAIRSCI FIMNG/GRADING O CAMPING UNITO <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE O Pe QwAZf- ' 3 <br /> .STRUC)URE/ADDI170N USE: 1-Oadt-OOr+l {-� /11CA,T / i) I 'f �.F?Z'rYICJ0M <br /> i (Ho nh/ n, ommertl Buvness; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: f//L/SiY/LJ vI (/ /MSI r <br /> z <br /> AP LOT PIAN MUST BE PROVIDED ON AN B'h XII SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS <br /> WILL BE RETURNED. <br /> DIRECTION-S FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <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 <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J \ <br /> AND INDICATE NORTH(N). T a z <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. I i <br /> 9. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS, LAKE,LOT LINES. 1 - <br /> 5. INDICATE IF A WALKOUT BASEMENT 15 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IFL—J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE J i <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. C7 l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (7_� <br /> g a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> L DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WFTHIN 60 DAYS OF PERMIT. CJ - <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. <br /> 9. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER (] <br /> SETBACK AREA. V <br /> 5. ACCESSORY STRUCIURE(GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> z > r. nr. o > or <br /> I declare that his application(including any accompanYing schedule)hasbeen examined by meandtothe bestofmy 0 5 .. <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuraq of all K a I <br /> information contained in this application(including any accompanying schedule)and Ifurtherdeclare that l recognize that this <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue n permit I ?. - ' y <br /> further accept all liability that my be a result of 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 S <br /> .z�have access to the above-described p.mises to res able[i efur Me purpose of inspect (� <br /> /'OWNER'S SIGNATURE C - 3 h <br /> (date) <br /> ZONING ADMINISTRATOR <br /> SEP-9 ZU13 in <br /> TOWNSHIP PERMITS MAY BE REQUIRED F <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSW"ETT COUNTY _ <br /> ZONING U N s U u <br />