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c rt Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a � <br /> APPLICATION FOR LAND USE PERMITS = <br /> OWNER I IN /'�` TELEPHONE <br /> rt ,J <br /> MAILING ADDRESS E <br /> �3�15 (Aa,r6f 115LpwN1 A��Poo��a w1��sa ,54g� � '� <br /> PROPERTY ADDRESS <br /> 0 <br /> LEGAL DESCRIPTION <br /> Tct,, oFsc�rr�S23 Tw2a Rig nI 664,' of E 66�' w N(w 1� A(nc� <br /> 'TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION DECK ❑ GARAGE/ACCESSORYISTRUCTURE ❑ �✓: <br /> 0 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS O FILLING/GRADING ❑ CAMPING UNIT ❑ .7 <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin; Commercial Business; Bedroom; 0k, etc,) <br /> BUILDING CONTRACTOR: <br /> n <br /> M <br /> K <br /> ✓ <br /> O > %W <br /> A PLOT PLAN MUST BE PROVIDED ON AN B 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS c_ <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. e d <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, a <br /> AND INDICATE NORTH (N). I� z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)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. O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES ±�P <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ;r <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 'o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. ]. o� - <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ry z 90 <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. 8 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. p <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7, <br /> eRi a 3 3 3 n a n I'q <br /> `" <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my a e ,°Z a a H a w <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the de[a]l and accuracy of all <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this °.> > N <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permR. I 'c v > <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit my offlc]als charged with administrating county ordinances or other authorized person to have " 4 o o $ t' <br /> access to the above-described Ices ata so able time for the purpose of Inspection. 5a g M in w A <br /> 4o yon,w„ o > <br /> OWNER'S SIGNATURE 1 <br /> —('' (date) P. <br /> �. N x 3 e. Z <br /> ZONING ADMINISTRATOR I✓n FIQY)[i9an 6' ` c <br /> �J <br /> �'" m <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ` <br /> �- <br /> �er/vt��a 1�fe✓pled ,�pby �}n�u Semp�P 9 <br /> 5-13- 0 <br />