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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator c o <br /> APPLICATION FOR LAND USE PERMITS <br /> 'Ol ry rl,i <br /> OWNERTELEPHONE <br /> MAILING ADDRESS � 0�.VG' SL cl Q,&tl. 7— �WW SrV(;'3 � 9 <br /> PROPERTY ADDRESS 4/0ew �, �.�L.� <br /> LEGAL DESCRIPTION �I/,�/,$�yJ�/O If/ ,QQ�/�E /c�"� �,AZ.v✓F�� LrI/ O <br /> SINGLE FAMILY DWELLING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAIRS ❑ ,or. <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ ..[ <br /> STRUCTURE/ADDITION USE: 1::-15Wm/ <br /> 10'4!;W( <br /> Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS .� <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) V` C C OM <br /> � � n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <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, M <br /> AND INDICATE NORTH (N). �j c <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 o <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. c y <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES �. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. °o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O o d <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE S, W <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. l� <br /> y I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 0) <br /> NEEDED. <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: r (/1 J <br /> Z <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. f ^ <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER v l <br /> SETBACK AREA. / O <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. d <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> S �ga�m�r6� M <br /> 7. Eio <br /> �•'�C aw <br /> I declare that this application(includingany accompanying schedule)has been examined by me and to the best of my knowledge �, y <br /> and belief R is true,correct and complte. I admosdedge that I am responsible for the detail and accuracy of all Information a 2_ yyy <br /> crm contained oviding willabe rcIIMo upon by the ieany accompanying schedule)and I further declare that County of Burns tt Wisconsin In deter I ng wiether tollssurecognize <br /> anp���fuis Information <br /> all <br /> liability that may be a result of the County of Burnett retying on this Information I am providing In this application. I agree to <br /> permit aunty oMcials charged with administrating county ordinances or other authorized person to have access to the above- r) <br /> described premises at any reasonable time the purpose of Inspection. A `r E y <br /> OWNERS SIGNATURE c ^n c > Z <br /> c (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' ^H <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />