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b Z <br /> Burnett County 7410 County Road K, No, 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER ` "„ r_. TELEPHONE �S / R . <br /> MAILING ADDRESS - <br /> 25 <br /> PROPERTY ADDRESS .7R � <br /> dfJ Ai�"T7JJ //775++" � \J <br /> LEGAL DESCRIPTION_ _/ i / /!/ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING d ADDITION ❑ DECK O GARAGE/ACCESSORY STRUCTURE in <br /> BUNKHOUSE ❑ 59,692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT O <br /> COMMERCIAL BUILDING ❑ OMMERCIALADD ION COMMERCIAL ACCESSORY STR CrURE O <br /> STRUCTURE/ADDITION USE'. /✓� '��` 1 � _ <br /> yHme/Cabin; mmmercclal Bu Ines; Bedroom; Deck;etc.) -Y/' P <br /> BUILDING CONTRACTOR: -(H'�F � .J. ,, !r r 7 ( _ ,2,946 7-7� <br /> o N <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS 0 0 <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) \JJ b <br /> I. 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, ( -> <br /> AND INDICATE NORTH (N). <br /> J. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (e) 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. C �� <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y l�rl <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. e — <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. I-rr n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n x <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. J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ( I <br /> SETBACK AREA. JI <br /> GE/STORAGE ONLY. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARA <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> '7. <br /> � > > <br /> 98b'c <br /> � xCS - too <br /> I declare that this aPPIIcaUon(including any accompanying schedule)has been examined by me and to the best of my g e Q �. <br /> Imowledge and bull-?it Is true,correct and complete. I aelmowledge that I am responsible for the detail and accuracy of all to <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this e w m 9 <br /> information I am providing will t>e relied upon by the County of oumett Wisconsin In determining whether to Issue a permit. I W �• �a�Y y y b <br /> further accept all liability that may be a result of thu County of Burnett mlying on this information I am providing In this & k,_ <br /> application. i agree W permit cou officials charged with administrating county ordinances or other authorized Person to ! a „ <br /> have access to the above-descrl d Irej at any arena ma for the purpose of Inspection. <br /> 1.01 16 <br /> OWNER'S StGNATUR (fie) al 2 <br /> p <br /> ZONING ADMINISTRATOR I an i Ciel <br /> TOWNSHIP PERMITS MAY BE REQUIRED M1 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w: I =µµ: <br /> � VN�Kb9N� <br /> y.Up 0000 <br />