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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITSCc <br /> W <br /> OWNED-�v'fl l°r�; C(k �Y( Iz.%tc�`lELEPHONE J1 353 7is-y✓e8 73aa a <br /> MAILING ADDRESS&d _ v) o <br /> R <br /> it�d( �// ( ; <br /> PROPERTY ADDRESS <br /> 1 I YpG o <br /> LEGAL DESCRIPTION (AL ( o <br /> 5E a � 6wlq 3 738N R 14 a) <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION,14,f DECK' GARAGE/ACCESSORY STRUCTURE 0 v, <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED 0 A <br /> STRUCTURE/ADDITION USE: L"1 d- Z c--' <br /> (Home/Ca n; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: O y— <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 th X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. 0 C — „— <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n '' <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, 3 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) ° <br /> Q( <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES -4 Q <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. _ <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. w OQ <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 /> p' S <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r ,..I t)NEEDED. <br /> THIS PERMIT IS SUBIECi TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'O Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE JREQUIRED WATER I` p <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. F <br /> 7. T > o 0 o Q n 0 b <br /> `fin n � 33nni am � <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 c <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all g, <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that thls D D m N <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I O4 R g a:— Y <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this c ' y w 7 <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have o t' <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. o^ o g to Nvs <br /> OWNER'S SIGNATURE //IIQg 1° a <br /> (da f oy, <br /> —ate � �� ` z <br /> � (1IG 3fl �° ) M <br /> ZONING ADMINISTRATOR )rn w o^ O by <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a^N <br /> � � 80008 <br />