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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g9 f ` <br /> APPLICATION FOR LAND USE PERMITS <br /> " <br /> W <br /> OWNER atr( nj'n n ,I l�nd TELEPHONE w <br /> MAILINGADDRESS (/ � ✓t�JP <br /> PROPERTY ADDRESS IX s (Q / 9 Br,C- <br /> v <br /> LEGAL DESCRIPTION �. <br /> o _ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECKGARAGE/ACCESSORY STRUCTURE O m _� <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE Elo . <br /> STRUCTURE/ADDITION USE: Q-�'C-1 k_ o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ti w <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS Co <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 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, — 5 <br /> AND INDICATE NORTH (N). \ \ Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) 0 7-' tWWWu o <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 q <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. S y , <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 I` o n, <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. iw <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHENi CA <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G <br /> G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z n n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. B A p <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 <br /> SETBACK AREA. [1 1 v J <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. Q <br /> 7. Do 0 o naE Zf <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 : <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all m d- _ <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this E. D a m N; <br /> Information I am providing will be relled upon by the County of Burned Wlsconsin in determining whether to Issue a permit. I S R a 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 o '� C ;,,d,= e+N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of inspection. m nc. � o <br /> y N W <br /> y 3 'sf m yc0000 > <br /> OWNER'S SIGNATURE / — /0eAe o. a <br /> Awa <br /> (date) <br /> ZONING ADMINISTRATOR�f it 1 r r �W I� `7 S 'N 'c w' N E p 'M <br /> TOWNSHIP PERMITS MAY BE REQUIRED G; <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �e(m� l �e erp IG�edt bil �sh Pew ✓p-Iq lb � � 00000 <br />