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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER Q <br /> TELEPHONE / <br /> (0 1 y 7f 17, <br /> o I <br /> MAILING ADDRESS V) Q. <br /> PROPERTY ADDRESS <br /> Q C) <br /> 0 <br /> LEGAL DESCRIPTIONC) <br /> 3 24 15w (LarI tix( CSAA Vol. 10 0 Rho <br /> TYPE OF PERMMS): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK ❑ GARAGE/ACCESSORY STRUCTURE J9I/ 1 rn <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 lv V <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 �' 2 <br /> Garaa� ,?/ x 40 <br /> STRUCTURE/ADDITION USE: _ z <br /> (Home/Cabin l.ommeraal Business; Bedroom; Deck; etc.) IL_ ° <br /> BUILDING CONTRACTOR: Y I-- <br /> n <br /> � y <br /> A PLOT PLAN MUST BE PROVIDED ON AN <br /> WILL 8E RETURNED. 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS p o_ <br /> I� 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. r <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW �% n <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). N 9J ^\ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) ° � 7' Z° <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. P' <br /> GIq <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES Oo <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 0 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y 1 <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 5 <br /> NEEDED. ...I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: `1• <br /> � � W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. vl� Cf <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. z <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. <br /> AN�O�T�TOpBE USED FOR HUMAN HABITATION. <br /> 6' IwTI-fj� Z(7V'li✓� b2�'D(-2 CD✓lS�Y-In-C'("LDn '_Yb CoVr�rm {�a�S <br /> 7. J <br /> D o 0 o N a 0 `d <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of mye o " _- <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all a - - <br /> o <br /> Information contained In this application(including any accompanying schedule)and 1 further declare that I recognize that thism a a y oW. 6 <br /> rn <br /> Information I am providing will be relled upon by the County of Burnett Wisconsin in detelning whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am pmvlding In this c c <br /> 5 w < b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have d <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. 8 8 0 <br /> OWNER'S SIGNATURE �... -�-� -' j l U c a <br /> a <br /> (date) o dao mrld � = Z <br /> / a F 3 $ <br /> ZONING ADMINISTRATOR <br /> yC11N w : nt� <br /> TO SHIP PERM MAY BE REQUIRED ao <br /> THIS PERMIT SHALL EXP?RE ONE YEAR FROM DATE OF ISSUANCE <br /> l vii lNii 8 O p NO 8 <br />