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dilipplift County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> e <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERTELEPHONE o <br /> L e� a r-\(,4-, a <br /> MAILING ADDRESS i, l OG E 1C n tl �vv� 1��u� 1A l�n� 'HY S 1� �1 L 5'32( } <br /> I p01 <br /> PROPERTY ADDRESS ny}2� L4 fPbCt Sloblb lJ,1cb5� er wT 5'7 M l <br /> oocc r (� �,j C- 0 <br /> LEGAL DESCRIPTION �IQ10. �M �% 1,o4O4 ' low« oT }Olie,l/e & <br /> Type of PERMIT(s): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(3V)GAZEBO 0 STAIRS FILLING/GRADING 0 CAMPING UNIT 0 <br /> b <br /> COMMERCIAL BUILDING 00y�COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: VI �l,l� - /l Wt LL �;ee - o <br /> (Home/Cabin; Commercial siness; Bedroom; Deck; etc.) C <br /> U <br /> BUILDING CONTRACTOR: C <br /> A PLOT PLAN MUST BE PROVIDED ON AN B%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS e <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C I o <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 at a I <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDINGS) <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. C7 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES . rn <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. p <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I J <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. I <br /> t C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN I �7 <br /> NEEDED. <br /> GV <br /> T.iIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. x (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a <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. lP <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOyR�HUMAN HABITATS N. � <br /> 6. S��ircrraL/7. <br /> 3 <br /> I declare that this application(including any accompanying schedule)has been mmmined by me and to She best of my 3o, <br /> knowledge and belief It Is true,torted and complete. I acknowledge that I am responsible for the de all and accuracy of all <br /> InformationeontaNad M epplkation(Indirdhtg any accompanying schedule)and I further dedere that I recagnlie that this m <br /> Information I arm providing I ba u by the County of Burnett Wkxonsln m determining whether to Issue a permit. I -� <br /> further accept ell(lab" be County of Sumett relying on this information I am providing In this <br /> application. I agree to with adminlabating aunty ordinances or other authorlaed person to have <br /> adeas to the above-d t ble time for the purpose of Inspection. 6 <br /> OWNER'S SIGNAT(Iin p y <br /> (data) 5 q . S a <br /> ZONING ADMINISTRA <br /> C, € � : <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br />