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Bumett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS (}� <br /> OWNER WJ� ! TELEPHONE ° <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCSz z :zgiV.eiG4l r0 <br /> —c <br /> RIPTION <br /> TYPE OF PERMITS) SINGLE-FAMILY DWELLIfyrrivw N <br /> n�Ep <br /> GCTURE O Cj <br /> - <br /> � <br /> BUNKHOUSE O 59.692(1V)GAZEBO O jSTAIRS O FILLING/GRADING O CAMPING UNIT O c 1G <br /> COMMERCIAL BUILDING ❑ MER IAL1DDITION ❑ Io ee <br /> TRUCTURE O <br /> STRUCTURE/ADDITION USE: /Yl - <br /> (Home/Cabin; Commercial Bus' ess; Bedroom; Deck; etc.) I <br /> BUILDING CONTRACTOR: <br /> n (n <br /> K y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCTE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. OMPLE _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a° <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m RK c <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, 9B <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) e <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK w <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. r' <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. a. , <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 Y.l c <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. UjJ 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN v, <br /> NEEDED. y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: U�) �, J <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n z J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY w <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQPERMITTED. <br /> UIRED WATER .� <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. Q <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. � <br /> 7. <br /> ^ �lann� a ro <br /> I declare that this application(including any accompanying schedule)has been ina mined by me and to the best of my 6 o <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all , z m <br /> Infonnatbn contained In this application(Including any a mDanylnq sdaulula and I further declare that I recegnize that this '��> <br /> Infonnatlon I am providing will be relied upon of the oreumett WBcpnsin in detenninlnq whether m Issue a permit. I m $w i b <br /> further accept all liability that may be a uB o/ my of Burnett retying on this Informatbn 1 am providing In this «« <br /> application. I agree m permit county ala ch with administrating county ordinances or other authorized person to have <br /> access to the above-desodbed pre at any nabk time for the u o C" <br /> p rpoas of inspection. e^ 8. <br /> �W <br /> OWNER'S SIGNATUR n > <br /> -- mn0 <br /> oHa_: <br /> --�� (date) o ° 6 5i Z <br /> ZONING ADMINISTRATOR_ �J {r}'� �`to <br /> ( /1 c a `'e. 5 <br /> GQ/� ,2 0 : e5 ; C � <br /> U <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> f°C/�ni� 1e �f�r�rci�eol �� bt� t3�/ah�sw�wsei, coa <br /> � i -1L-D <br />