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i z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c ° <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER /VSLEPHONE <br /> MAILING ADDRESS01) <br /> PROPERTY ADDRESS 5Af6lf S'YP3a 0 <br /> LEGAL DESCRIPTION I/ oS YV) <br /> TYPE OF PHtMTr(S): SINGLE-FAMILY DWELLIN ADDITION ECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 S9.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING O CAMPING UNIT 0 ct <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERJ jL ACCESSORY STRUCTURE ❑ S <br /> 106ri. i 3 1 3� <br /> STRUCTURE/ADDIREnf-rAlU e <br /> ON USE: c� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) S <br /> BUILDING CONTRACTOR: '0 J� R r' 6(s O fn 7"'C' <br /> S �uanti 7/5'"- 635- 7165' <br /> A PLOT PIAN MUST BE PRDVI D ON AN 8 nh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. 0 <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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, (?1 <br /> AND INDICATE NORTH(N). z p <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 p <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. p SU <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES J <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. �, l <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. -C l <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE o <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 ..j G1 <br /> NEEDED. Z <br /> a � <br /> THIS PERMIT IS SUSIECT TO ALL CONDITIONS LISTED BELOW: C 7� o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z O �I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <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 I� <br /> SETBACK ARTA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR <br /> NOT TO BE USED FOR HUMAN HABITATION. PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 91 <br /> 6. f <br /> 7. 3 3 R c IV <br /> 1 declare that this application(including any aaanpanylng schedule)has been examined by me and to the best of my <br /> Wwwledge and belief It Is true,corned and mnplete. I admaMedge that I am responsible for the detail and acoxacy of all <br /> information contained In this application(WdrMing any ackampanying schedule)and I further declare that I recognize that this '� E.>>m . <br /> Information I am Pm Wing will be relied upon by the County of Burned:Wisadrsln W determining whether m Issue a pmnit. I Y <br /> further accept all Ilabgky Nat may be a resuk of the County of Burnett relying on tlas Information 1 am providing in this �^" <br /> application. I agree W permit county olBdals charged with administrating kcunty ordinances or other authortred person to have <br /> access to the above-described premises atthe purpose of Inspec ion. <br /> S �w <br /> OWNER'S SIGNATURE am/reason rs '° m tl w++ O <br /> (data) o M _.F <br /> ZONING ADMINISTRATOR O �� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL Q(PIRE ONE YEAR FROM DATE OF ISSUANCE c <br /> (Mi�� 4- !z�4-(/_sled fD Ph t//&S thOVs a -II U U s o 0 o s <br />