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SumeM Count/ 7410 County Road K, No. 102, Siren, WI 54872 Office of Zonina Administrator <br /> APPLICATION FOR LAND USE PERMITS i u �El <br /> s <br /> OWNER �� I c <br /> h`i l TELEPHONE �- <br /> LU <br /> MAILING ADRES; I I(� <br /> Q <br /> ��� I� Ialay� <br /> PROPERTY ADDRESS n <br /> LEGAL DESCRIPTION �.{- <br /> See alta r (ti vii <br /> TYPE OF PEIL+ITS): SINGLE-FAMIC!DYr`cLLiNG u ADDITION Ll DECK O GARAGE/ACCESSORY STRUC7I_IRF ❑ I ... <br /> d � <br /> BUNKHOUSE 59.692(1V)GA7EBO n STAIRS ❑ FILLING/GRADIN-0 CAMPING UNIT <br /> I I <br /> COMMERCIAL BUILDING u_ COMiiEeRCiHL ADDITION U�J�C�OMMERCIAL ACCESSORY STRUCT RF O A i I o a N� <br /> STRUCTURE/ADDITION USE' Cd'.l�y��.QAJ 6 P1� f�O �� <br /> (HOme/..atm; COaTmtel6 , Business; Bedroom; / ecu; etc.) <br /> BUILUING CONTRACTOR: <br /> vi I�Q)I <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 SHEET OF PAPER, ANY INCOMP!FTE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAW:TO SCALL. ) e I W <br /> 7. SHOW THE LOCATION ,AND SIZE OF ALL EXISTGiG BUILDINGS/STRUCTURES (E8) AND ALL NEW <br /> BUILDINGS/STRUCTUREES (NB), INCLUDING UECKS, PORCHES AND OTHER STRUCTi IRE9, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDNG(5) I� rJ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK w 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 q C <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. m <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Yt <br /> Y I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE l� y <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCfURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN y w <br /> NEEDED. I!�� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. qj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. („(1I <br /> ALTERATIONS3. NO GRADING OR SHORELAND <br /> 4. NO S RUCTURES INCLUDING RETA NING WALLS ALLOWED <br /> ALLOWED WITHIN THE REQUIRED WATER ` LLL O <br /> SETBACK AREA. I I` <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. ^ >e�A,nt o>. <br /> ISM m <br /> I declare that this application(Including any accompanying schedule)has been e>mmimed by me and to the best of my pa ? <br /> knowledge and belid R Is true,correct and complete. I admowledge that I am responsible for the detall and accuracy of all i;.ua c P <br /> yi -j <br /> Information anttlnod in this application(IncWdnp any accompanying schedule)and I haMer declare that I recognize that this S <br /> Information I am providing will be railed upon by the County of Burnett Wisconsin In determining whether to issue a per lL I <br /> further accept all Ileblity that may be a remit of the County d Burnett relying on tilb Mfarrrhatloll i am providing N this <br /> epplkotlon. I agree to permit county aMdab eirorged with admnbaatYg county ordinance or other authorized pawn to have <br /> access to the above-0esc abed prembea at any reasonable time for of inspection. <br /> ` <br /> OWNER'S SIGNATURE <br /> In <br /> t IF <br /> ZONING ADMINISTRATOR - 2. <br /> M <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ` �»_r4 o o g <br /> 0 <br />