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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator P <br /> APPLICATION FOR LAND USE PERMITS CN <br /> OWNER r TELEPHONE <br /> cr <br /> V p / <br /> � <br /> MAILING ADDRESS a 897 JA) Yel IoW �d VLY- ICC '&"j /_ <br /> PROPERTY ADDRESS 6 CJ <br /> o � <br /> LEGAL DESCRIPTION Q <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE rn <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> Sy S' <br /> STRUCTURE/ADDITION USE: I UrCAQIg , c� <br /> ( / b \ o <br /> Home Ca I Comrrwr'aai Busbtss; Bedroom; Deck; etc.) � <br /> BUILDING CONTRACTOR: <br /> Ky � <br /> A WILL BE RETURNED.PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) f1 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW f�+f as �% o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 9 <br /> AND INDICATE NORTH (N). '9 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS) TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' <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 W <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. IAV <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN (J� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. '� r <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. r�� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATERSETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION.6. :� <br /> 7. g 00 0p�p±± > � i <br /> R n � aIaRal <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my o 0 `° ^9 90 $,°o w �, <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all o <br /> information contained In this application(Including any accompanying schedule)and I further declare that 1 recognize that this >> m <br /> Information I am providing will be relied u g permit. I <br /> upon by the County of Burnett Wisconsin In determining whether to Issue a d <br /> 5- 9 c c <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am providing in this o p 4 a�' <br /> application. I agree to permit count dais charged with administrating county ordinances or other authorized person to have L) 0 -N ry <br /> access to the above-described pr Ise at any asonab e f the purpose of Inspection. p m g H <br /> /moi eo > 8cgo <br /> OWNER'S SIGNATURE / rt c n g <br /> n V5 ancon N ?l ; <br /> (date) 0 a 0 ��. <br /> ZONING ADMINISTRATOR �m <br /> H <br /> TOWNSHIP PERMITS MAY BE REQUIRED C A <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> eI'461 f)cCk20( L�o bl- 5e/- Fi se6-e r 8--�&- <br />