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L <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator _ <br /> APPLICATION FOR LAND USE PERMITS = } <br /> OWNER -JClSOn C 1./r 'c K.'n Scn TELEPHONE 7/S- 6 /V' 7.29A <br /> C <br /> MAILINGADDRESS /p�,3 L� dr<.yr 2!L A/aWre", <br /> PROPERTY ADDRESS o2Pn.7S /Y!✓. SP�nP/� tv-T- Cl <br /> LEGAL DESCRIPTION , IrCL GD✓ Z07- & (LOl 2 't^A` D-71/) j,2y jyg't/.P/yr✓ _ <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION IB DECK CI GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(l V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING Cl CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION 13 COMMERCIAL ACCESSORY STRUCTURE❑ _ <br /> STRUCTURE/ADDITION USE: _1Gn✓!!7 .3 SP45 on OO re ll f0 Z <br /> (Home/Cabin; Commercial B� Bedroom; Deck; etc.) <br />`—'BUILDINGCONTRAGOR:- ' SP/7C - - - - -et <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8% X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. T _ <br /> = a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL 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, C , 9 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OFTHE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) 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. �'tU rwi <br /> - <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES if <br /> TO BUILDINGS, ROADS, TAKE, LOT LINES. p <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. nn <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. -� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> 11 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r h <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n a <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. O <br /> __.___4. NO STRUCTURES„INCLUDING RETAINING WALLS,_ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. 9 <br /> 6. <br /> 7. > > <br /> n n n <br /> I declare Mat his hef It Is <br /> (Inducing any accompanying schedule)has been examined of r and to l a best of my g o j = :, 6 a?im <br /> knowledge and belief I[Is True,correct and complete. 1 acknowledge Ma[1 am responsible for Me deMll and accuracy of all m d-n - <br /> infonnation contained In this application('mcluding any accompanying scheOule)and I further declare Mat I recognize Mat this =>>.'t <br /> Information 1 am providing will be rolled upon by Me County of Bumex Wisconsin In determining whether to Issue a pernR. 1 - - <br /> further accept all Mobility Mat may beo result h ne County of Burnett relying county <br /> Nis ordinances <br /> r o 1 r a providing In this �+' <br /> application. 1 agree to permit countyofficialsat <br /> n creased with tome <br /> for Me Purpose <br /> county oNlnanaes or other authorized person to have <br /> access to Me above-described premises at any reasonable tlme for Me purpose of Inspecgon. - m � u rI <br /> OWNER'S SIGNATURE N + <br /> ZONING ADMINISTRATOR/I <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> k <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSURNM COUNTY <br /> ZONING <br />