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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator `lo <br /> APPLICATION FOR LAND USE PERMITSir <br /> OWNER Mfc�lAcC � jp TELEPHONE 7i5--733'C6yd <br /> MAILING ADDRESS acT 4r�O of`o An <br /> VV J /� •U l <br /> PROPERTY ADDRESS K /Jrc�fgncr /lo y�.✓�d� <br /> LEGAL DESCRIPTION <br /> 7? UO✓ OZ I !J c/R NE�Ct` CO G✓� - I <br /> TYPE OF PERMITS): SINGLE-FAMILY DWELLING X ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION D COMMERCIAL ACCESSORY STRUCTURE ❑ 3 <br /> STRUCTURE/ADDITION USE: lJ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: JaItAiii P4071`11"t"A �,rltE ZJE /i(�C <br /> 7/S•566'SLS - <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS z c <br /> WILL BE RETURNED. O <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 V <br /> BUILDINGS/STRUCTURES INS), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, z) b <br /> AND INDICATE NORTH (N). I 1 z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)To ALL LOT LINES, (B) BUILDINGS) O e ' <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK , <br /> (OHW M) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND(D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST) AND DRAINFIELD(Di AND ALL DISTANCES SU y <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. S <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n <br /> 5. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE (n g <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER, <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ) �— <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: F (D <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 9 (; <br /> 3. REMOVAL OR CUTTING El TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE SIL L <br /> 3. NO GRADING ES SNCLUDING ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER L7 <br /> SETBACK AREA. LV I" <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6 <br /> 2, PE <br /> z 3 3 3 -, <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 o ,2 2, a .N= _ <br /> knowledge and belief it Is true,correct and complete. I acknowledge Nat I am responsible for the detail and accuracy of all - - <br /> information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this =. > > c - w <br /> 'information 1 am Providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability Nat may be a result of the County of Burnett relying on this Information 1 am providing In this <br /> application. 1 agree to Permit county officials harged with adminis(rsting county orcnances or other authorized person to have ?j o iv Q cr r <br /> access to the above-described prem se s at aqq reaso9}ble Cg f /( purpose of inspection. (] <br /> 2oi3�wv�i <br /> OWNER'S SIGNATURE > <br /> ZONING ADMINISTRATORFr 1 Fit <br /> TOWNSHIP PERMITS MAY BE REQUIRECTHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE '^ <br /> A 1FTCIONTY _ <br /> ZONING <br />