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C n Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g ° <br /> APPLICATION FOR LAND USE PERMITS N = <br /> s' <br /> _ t � n <br /> OWNER �bvl.-1- SI��tA F—�ItA�oe` TELEPHONE _ LS�l_ �'e/_ <br /> MAILING ADDRESS //6/ n�Y�n'• ��� n'/ �� �"�l�O� v� _ <br /> PROPERTY ADDRESS <br /> ��e /rcQ Shy D�rreO�trl sllr /�7yGd a s <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ v� <br /> BUNKHOUSE 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ o <br /> STRUCTURE/ADDITION USE: C) k. Z s <br /> (Home/Cabin; Com0 0'nmercial Business; Bedroom; Deck; etc.) � � Y <br /> BUILDING CONTRACTOR: TC`e tno uC�(`c` <br /> O W <br /> A PLOT PLAN MUST BE PROVIDED ON AN B 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m C a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C O <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, R <br /> AND INDICATE NORTH (N). 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 w' m O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p v <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES ^. N O •• <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. V) <br /> THIS PERMIT IS SUBIECi TO ALL CONDITIONS LISTED BELOW: r. <br /> O w <br /> wF Q '1 V• G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. S <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER y <br /> SETBACK AREA, O <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. w0 <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. anr)nc agro <br /> n ^m � 33 � ca tr' <br /> I dedare that this application(including any accompanying schedule)has been examined by me and to the best of my ` c . . . . <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m = 'm' <br /> Information contained in this appllcatlon(Including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I d a 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 c <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have c),°2 0 �" $ o ,r. <br /> access to the above-described premises at any reasonable a for a purpose of Inspe on. y o g o o g y <br /> OWNER'S SIGNATURE 6 6 �~^f;En' <br /> (date) 2 <br /> r <br /> a o' <br /> 6 9 T.� <br /> ZONING ADMINISTRATOR m _ I f1 I yw' c) t" <br /> \J <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ti <br />