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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n c <br /> APPLICATION FOR LAND USE PERMITS a — <br /> ZmH CN <br /> �J A <br /> OWNER ,A ^ I�Ig/ r ' qnTELEPHONE �p 0 - 7.51 8 a <br /> MAILING ADDRESS /S (� g G t?-';,v roT 5 % 6 LAJ-L S3 - `. O <br /> PROPERTY ADDRESS01 (e gJ Co ti o G. w 1 y I 401 <br /> LEGAL DESCRIPTION <br /> A <br /> CSM vas ,a60 <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE❑ ADDITION O STARS-0 o <br /> TYPE OF PERMIT(S): 'v <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECI ❑ <br /> STRUCTURE/ADDITION USE: Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o_ <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT I ILANS r' <br /> WILL BE RETURNED. 0 < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M I� 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, t�'i: 'q <br /> AND INDICATE NORTH (N). 1 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDI G(S) c <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK a <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 DISTA NICES �. c <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O e Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE v. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. R --. <br /> 1 <br /> y � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE W EN <br /> NEEDED. ( U1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (4 <br /> r Y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. �r p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <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 L C <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE C NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. Q <br /> 6. g <br /> 7. <br /> IT <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my know) ge z w g a ^y <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ^ e ? <br /> contained in this application(Including any accompanying schedule)and I further declare that 1 recognize that this Infomatloi i 1am <br /> liabilitythatmatll be relled y be a result of thon e County o the BBurnett reof lying on this informationnsin In lng whether to I am providingIn this ue a application.Iher accer agree to t all n u c N N$ <br /> permit county officials charged with administrating county ordinances or other authorized person m have access bD the above 8 <br /> described premises at any reasonable time for the purpose of inspection. to <br /> c p. <br /> .?y <br /> OWNER'S SIGNATURE ./Y/ G / o n 9 <br /> (date) <br /> ZONING ADMINISTRATOR I ^ �`w" <br /> V � P7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N N: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 t2;5 o <br /> i <br /> I <br />