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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administratorc n Z <br /> APPLICATION FOR LAND USE PERMITS 0� <br /> OWNER Chni ���n �. d0rn. Vont.') TELEPHONE c)-C)' (D 50- IS15--7 a -� <br /> f (( ` �� R <br /> MAILING ADDRESS <br /> —7'?qct 40 \v� � Ib� ( 5� ✓0 <br /> � ']p <br /> PROPERTY ADDRESS �� \ 'I-�C-IV (it", 1. l�.� ,e� akLu fc.l W <br /> LEGAL DESCRIPTION <br /> SINGLE FAMILY DWELLING 11 GARAGE/ CESSORY STRUCTURE RRtl ADDITION ❑ STAIRS ❑ ,or, <br /> TYPE OF PERMIT(S): .° <br /> FILLING/GRADING❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ ^� <br /> STRUCTURE/ADDITION USE: Ao rix Z 3 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) j- <br /> BUILDING CONTRACTOR: S hef .M, r I <br /> A PLOT PLAN MUST BE PROVIDED ON AN 0 V2 X11 SHEET OF INCOMPLETE OR ILLEGIBLE PLOT PLANS C 3, <br /> WILL BE RETURNED. <br /> o_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) n <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BESHOWN OR DRAWN TO SCALE, tin 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING UILDINGS/STRUCTURES (EB)AND ALL NEW C <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS PORCHES AND OTHER STRUCTURES, 'O <br /> AND INDICATE NORTH (N). I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK v <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAN AREAS,AND (D)LOT DIMENSIONS. 7 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TI NK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES yj o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w OQ <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED A14D SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHII ECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE q <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKE D SO AN ONSITE VERIFICATION MY BE DONE WHEN d <br /> NEEDED. ( (/J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r Z O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <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 Q- <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. j F <br /> 6. <br /> syn mQ> e'� <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It is true,correct and complete. I acknowledge that I am n sponslble for the detail and accuracy of all Information o <br /> contained in this application(including any accompanying schedule)a id I further declare that I recognize that this Information I <br /> liability that <br /> will be relled a result of thon e Couthe nty of Burnett relying of lyWisconsin on this I formationing I ampether to providingI In this ue a aermit I application.furthere�p[all <br /> liability Y County DD 9 L7 <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for the purpose of Inspectil kn. to <br /> OWNER'S SIGNATUR�Yu✓J O . __ <br /> �-J (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 8 U <br /> p�✓rn { jL2j-k/ pjt, (CV I.p kD-j D'l Tena C.h✓�s �r5`a3 87 <br />