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C m Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> MAILING ADDRESS ( l�—13Rl✓22`3t� U, <br /> / <br /> SIL13 Nu2d <br /> .r�hj G,f Nu���rnn1 ���� o <br /> PROPERTY ADDRESS 5" / Ps'oSpe - <br /> c - f�V e .Ir_� C, -� <br /> _C o C <br /> LEGAL DESCRIPTION o <br /> O <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK O GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING' ❑ COMMERCIALL ADDITION ❑ COM/MERCIAL ACCESSORY STRUCTURE ❑ c <br /> STRUCTURE/ADDITION USE: lie htc �e_16 UrQCIC_ o <br /> (Home/Cabin; Com ercial Busin s; Bedroom; beck; etc.) VTI <br /> BUILDING CONTRACTOR: o <br /> � y <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. 'h^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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 r� w <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3 B <br /> AND INDICATE NORTH (N). N Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) P <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK 9 Q <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES 1 Q) <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. oQ <br /> a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ,� .� O, <br /> NEEDED. <br /> 1 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I r- <br /> C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Y P <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q 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. i <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. T r' 0 0 0El El REF <br /> 6 ro <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 3 0 `g' q q <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all g, m = E <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this `° °- D D E N <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I a a w= b <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ° �.°7, 0 8 : 8 <br /> access to the above-described premises at anyre onable time f p rpo of Inspection. m a w N n <br /> 3s7 " 'y $ $ o8 $ > <br /> OWNER'S SIGNATURE <br /> (date) c c o = Z <br /> c Ei a xa <br /> ZONING ADMINISTRATOR �.j 5, .F w' <br /> TOWNSHIP PERMITS MAY BE REQUIRED c w <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> .. �� 00008 <br />