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C A Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a P <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> , `` ' , Y`` - 1 I 1 <br /> V SAM <br /> MAILING ADDRESS <br /> 0 <br /> PROPERTY ADDRESS �] {� C <br /> A VAN VTI ✓L 4.J(nn�V`�� W1 \ 0 1 <br /> LEGAL DESCRIPTION11 h C � ` � Wn J+S `n I �4 �fU o <br /> TYPE OF PERMIT(S): SINGLE- AM Y DWELLING ❑ AD ITION ❑ DECK ❑ GARAG /ACCESSORY STRUCTURE <br /> BUNKHOUSE C 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT C j <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION COMMERCIAL ACCESSORY STRUCTURE <br /> ( <br /> STRUCTURE/ADDITION USE: v i^r'� ) <br /> (Home/Cabin,,—Commercial Business; Bedroom; Deck; etc. <br /> BUILDING CONTRACTOR: <br /> C7 n <br /> � s <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANSC.o <br /> WILL BE RETURNED. 0C- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) r' ` <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, b <br /> AND INDICATE NORTH (N), z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) I ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK E. <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <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 /> 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. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN C <br /> NEEDED. ,q <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: r- C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'A a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. y <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. UI <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> ^ � annnciaoo <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my B 0,°� =3no ' <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this 5. y > <br /> information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I Y <br /> further accept all liability that may be a result of the County of Burnett relying on this information 1 am providing in this a- r ;p = s+4 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. <br /> m ,� a wwNwf� <br /> OWNER'S SIGNATURE z m R a <br /> ZONING ADMINISTRATOR I m `W /ie jL,2n =9' " F g 'j <br /> d � i a ern <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Q <br /> Peca) 1 d- N4-W pt&ed &tllo b y Obtaa Fore(- ¢Cae✓a«l 7"(0. -t)74 <br />