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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS s <br /> OWNER TELEPHONE <br /> Q(t.fo Y\, <br /> 0 <br /> MAILING ADDRESS /, x X133 I � ' $ E7 <br /> l oW e 61 er W <br /> PROPERTY ADDRESS I r� <br /> LEGAL DESCRIPTION <br /> TYPE OF PERMTT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE G <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ o O <br /> o <br /> COMMERCIAL BUILDING ❑ COMMERCIALADDITION0 �OMMERCIAL ACCESSORY STRUCTURE❑ <br /> STRUCTURE/ADDITION USE: - r L.I <br /> ome in; ommeraa usiness; room; c ; e . G <br /> n <br /> BUILDING CONTRACTOR: Z <br /> G <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLAITS � o. <br /> WILL BE RETURNED. f1 p <br /> p a^ <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 p p ° <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, m' 7 <br /> AND INDICATE NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE 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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES a <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE 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 U <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEM i <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r] p. <br /> d G z S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Q � <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. <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. C <br /> NOT TO BE USED FPR HUMAN HABITATION. f <br /> 6. �-F i(y 5iQ�ytLri cannot ba- IO+-, MU_ be ConSldeiedaS ave �O+ � a n n n n a o ro <br /> 7. <br /> o � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my y rp 2 : > <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all 'aC <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this o, <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ,P—, p d' �+ ; 7D o t- <br /> further accept all liability that may be a resua of the C unty of Burnett relying on this Information I am providing in this o � y <br /> application. I agree to permit county officials charg with administrating county ordinances or other authorized person to ave �, R d'w u 0 9 <br /> access to the above-described ses at any rea his time for the purpose of inspection. -2 H S o 0 0 <br /> OWNER'S SIGNATURE O ( I n f° c? oI n m Z <br /> 0 <br /> (d e) o : Grs.o r .7 <br /> ZONING ADMINISTRATOR ,J(i I JR o I i aar j F a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> + Ie44er Picked qp bL, IaWsSDrenso0 XNI-11 <br />