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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Offlce of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS <br /> w w <br /> OWNER G A D L I TELEPHONE <br /> MAILING ADDRESS / 027A O27 ti f I r �* n n <br /> PROPERTY ADDRESS <br /> 10 —? -7-7`� � ,.'� T <br /> LEGAL DESCRIPTION <br /> LO-f, <br /> TYPE OF PERMIT(S): SINGLE FAMILY DWELLING O Y GARAGE/ACCESSORY STRUCTUREX ADDITION ❑ STAIRS ❑ S <br /> FILLING/GRADING ❑ CAMPINGUNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ G9 tl ) <br /> STRUCTURE/ADDITION USE: —5 r Ah IL�9• "1 <br /> (Home ppabin; <br /> Commefficial Business; Bedroom; Deck; etc.) {- <br /> BUILDING CONTRACTOR: 04Lc.4 S 111-614 f fS Go H-T-t. <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS n <br /> WILL BE RETURNED. A 4 <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. �7 T <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW ❑ <br /> BUILDINGS/STRUCTURES (N8), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) 9J <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK J <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 o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. v l c <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 y <br /> NEEDED. <br /> THIS PERMIT IS SUB3ECr TO ALL CONDITIONS LISTED BELOW: <br /> f� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <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. U� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �(+, <br /> SETBACK AREA. UJ <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> I declare the this application(including any accompanying aclhedule)has been e:omNbd <br /> end belld k b tms,correct and corn by me and u the beat of Information a. : <br /> contained In this application(Including accompanying schedule)and I further declarre dugall and aaorrary a all is Information <br /> am Providing will be raked upon by the County of Burnett Wisconsin In determiningrsue a pe the this le er accept <br /> I d . <br /> whether m True a .- Ygt <br /> Ilabklly the may be a rhtauk d the County d Burnett ndylrhp on this Inf smatlon I am providing M this app tion. I agree to all r '8"�u o to <br /> permit county oftleb charged with administrating county ordinances or other authortied person to have acness to the above• S p n <br /> described pranbes at any reasonable time for the purpose of Inspection. m y <br /> OWNER'S SIGNATUR <br /> E-4— <br /> O <br /> 6 <br /> (� (date) 6 y <br /> ZONING ADMINISTRATOR nL Q <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 o. <br />