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Bumett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y: . <br /> OWNER TELEPHONE117 <br /> MAILING ADDRESSv <br /> X3/3 '�arj S+ �l G.((ke �Iv✓�� /1yC1 <br /> O 2 1 <br /> PROPERTY ADDRESS <br /> G�o 38 r3 /Y14I/r_-l I H k� �UG✓` �/✓QIJ"` r �N( SIO ( J c� <br /> I z °<. <br /> LEGAL DESCRIPTION N F E <br /> - s .. ;. ` <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK GARAGE/ACCESSORY STRUCTURE 0- m <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> r <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ ° <br /> STRUCTURE/ADDITION USE: Z <br /> (Home Cabin Comm tial Business; Bedroom; Deck; etc.) - <br /> BUILDING CONTRACTOR: <br /> n <br /> �t y <br /> 0 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'k X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o_ <br /> WILL BE RETURNED. <br /> �r n <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 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 6 .e <br /> AND INDICATE NORTH (N). �11 z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) i ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK R) <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. 1 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 1 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ° y <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 o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> ( VI <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. (� 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p^ <br /> of � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. R a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. _ I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. ana ro <br /> F n .°e 3 3 3 ' ? <br /> PP (including Yaccompanying ) Y y 'F Z '6' n a ni��'5 <br /> I declare that this application Includln an schedule has been examined b me and[o the best of m 3 e ,z <br /> knowledge and belief It Is true,tortect and complete. I acknowledge that I am responsible for the detail and accuracy of allInformation <br /> Information nt i ed in this <br /> will be relied lication including any accompanying schedule)and I further declare that I recognize that this .^$ c > n a N Y <br /> P g upon by the County of Bumett Wisconsin In determining whether to Issue a permit. I p <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 pertnit coun charged with administrating county ordinances or other authorized person to have o a�° g g t" <br /> access to Me above-described p t a reasonable tl for Me purpose of Inspection. c <br /> 'l .. gU Nals <br /> OWNER'S SIGNATURE / U 1 V a g o o g g <br /> (✓date) a d o g <br /> .c e <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N N N <br /> N U g O O O g <br />