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-Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P 3 <br /> APPLICATION FOR LAND USE PERMITS N C� <br /> OWNERwnTtF�� i Ay r TELEPHONE72 2 <br /> o <br /> MAILING ADDRESS (O I I _ , ( �--. L � e I o <br /> PROPERTY ADDRESS .(—n O` \ ,� <br /> 2c;1 <br /> r7 <br /> o <br /> LEGAL DESCRIPTION z L S L �C• f� o <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION O DECK O GARAGE/ACCESSORY STRUCTURE O I v� <br /> 5 <br /> BUNKHOUSE O 59.692(1V)GAZEBO O STAIRS'( FILLING/GRADING O CAMPING UNIT O <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE O S' <br /> STRUCTURE/ADDITION USE: /��1- f /IZUr �G C _ o <br /> (Home/Cabin; Commerdal Business; 8edroo ; Dedc; etc.) <br /> BUILDING CONTRACTOR:,_ A—&FeO 5 <br /> � y <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 <br /> WILL BE RETURNED. 0 C ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C O <br />+' 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW In 'O 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, p <br /> AND INDICATE NORTH(N). N -� o <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 <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 - <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. 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. <br />.. NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,- (G <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WCTHIN 60 DAYS OF PERMIT. n ,z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B a <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 a I1 <br />' SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FO$HUMAN HABITATION. _ <br /> 6. :1'Coo G. Cti-o,. <br /> 7. V >y >r,° <br /> ^ 3 <br /> I declare that tlds application(Including any accompanying schedule)hes been examined by me and to the best of my <br /> knowledge and belief It Is true,conect and complete. I admowledge that I am responsible for the detail and accuracy of all to E g C a <br /> Information contained In this application(ktdudeg any accompanying schedule)and I further declare that 1 recognize that this E.>>to <br /> Information I am providing will be raged upon by the County or Burnett W hwnsln In determining whether to Issee a permit. I --- <br /> 1 $�" > <br /> further swept all liability that may Cou f Burnett relying on this Information I am providing In this 6 '� u,i,``'_D 'rod <br /> application. I spree to permit <br /> offkee de d adm unty ordinances or other authorized person to have <br /> etaow to the above-described p ear et en sonab purpo Inspection. 5 " V S f] <br /> o� § n " 88888 <br /> OWNER'S SIGNATUR - Y ZS- l a <br /> > -,tvpgv,.n0 <br /> (date) <br /> ZONING ADMINISTRATOR <br /> � n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U 8 0 0 0$ <br />