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C N Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> (�V) 612461/-337P <br /> OWNER TELEPHONE150—113 U <br /> MAILING ADDRESS �iVSJ3 47 <br /> PROPERTY ADDRESS 2�/57 Ala-T SS L+1F/lG �� Y /Zbs Y�ee-, r _� 5-11'51_7 pp^ o <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMIr(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE <br /> pp ll <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ N <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED a <br /> STRUCTURE/ADDITION USE: CPA re4Z <br /> o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ¢ � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 14 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o (� <br /> WILL BE RETURNED. y \ <br /> a <br /> DIRECITONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) m o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. y n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW th v <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, r� <br /> AND INDICATE NORTH (N). N a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK Q <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 s <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. cn <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. I .1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (fJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z 1! <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. A 0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <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. <br /> 7. o 0 o n c p b <br /> aV <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a d==m <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this .o D c W y <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I .� cw <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this ;A n <br /> application. I agree to permit county officials ch ged administr ting county ordinances or other authorized person to have " c <br /> access to the above-described premises a nabie =meepurpase of inspection. `� o. <br /> ga <br /> yoogg y <br /> OWNER'S SIGNATURE ( �y ^ 'H y c m n p^_a O <br /> (date) a9 �. Ej. <br /> ZONING ADMINISTRATOR rn lo_j� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE « " <br /> � m�� l424-W pl cke d �bp 611 Ph,I (3rue L/-,)- <br />